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目的:探讨HBsAg定量监测对干扰素个体化治疗HBeAg阴性慢性乙型肝炎的指导作用。方法:2010年11月至2013年11月本院就诊的62例HBeAg阴性慢性乙型肝炎患者,采用α-2b干扰素500万IU,皮下注射,隔日1次治疗。抗病毒治疗至24周时根据HBsAg定量下降情况进行分组。HBsAg定量下降≥1 lg IU/mL的患者纳入A组,HBsAg定量下降<1 lg IU/mL的患者随机分成B1组和B2组。A组和B1组继续给予α-2b干扰素治疗,B2组加用阿德福韦酯治疗,疗程共48周。所有患者随访24周。结果:A、B1和B2组的持续病毒学应答率分别为88.2%,22.7%和59.1%。A组和B2组持续病毒学应答率比较,差异无统计学意义,且明显高于B1组。随访24周时A、B1和B2组HBV DNA较基线下降幅度分别为[(5.00±1.62)、(2.70±1.52)和(4.13±2.00)]lg copies/mL,B2组HBV DNA较基线下降幅度与A组接近,明显大于B1组。A组患者HBsAg平均下降幅度高于B1组和B2组,最终A组有2例(11.8%)HBsAg消失,B1和B2组均为0。结论:HBsAg水平变化与HBeAg阴性慢性乙型肝炎患者抗病毒治疗持续应答相关。干扰素治疗24周时HBsAg下降≥1 lg IU/mL的患者持续病毒学应答率显著高于HBsAg下降<1 lg IU/mL的患者,对干扰素治疗24周时HBsAg下降<1 lg IU/mL患者可联合阿德福韦酯以提高持续病毒学应答率。
Objective: To investigate the role of HBsAg quantitative surveillance in the individualized treatment of HBeAg-negative chronic hepatitis B with interferon. Methods: From November 2010 to November 2013, 62 patients with HBeAg-negative chronic hepatitis B in our hospital were treated with 5 million IU α-2b interferon subcutaneously once every other day. Antiviral therapy was divided into groups according to the quantitative decrease of HBsAg at 24 weeks. Patients with a declining HBsAg level of ≥1 lg IU / mL were enrolled in group A, and patients with HBsAg quantitation <1 lg IU / mL were randomized into groups B1 and B2. Group A and B1 continue to receive interferon alfa-2b, B2 plus adefovir dipivoxil treatment, a total of 48 weeks. All patients were followed up for 24 weeks. Results: The sustained virologic response rates in groups A, B1 and B2 were 88.2%, 22.7% and 59.1%, respectively. The sustained virological response rates in group A and group B2 were not significantly different, and were significantly higher than those in group B1. The HBV DNA levels in groups A, B1 and B2 at 24 weeks after follow-up were (5.00 ± 1.62), (2.70 ± 1.52) and (4.13 ± 2.00) lg copies / mL, respectively Close to A group, significantly larger than B1 group. The mean decrease of HBsAg in group A was higher than that in group B1 and group B2, and in the final group, HBsAg disappeared in 2 (11.8%) in group A and 0 in group B1 and B2. Conclusion: The change of HBsAg level is associated with the sustained response to antiviral therapy in patients with HBeAg-negative chronic hepatitis B. The sustained virological response was significantly higher in HBsAg-treated patients who had a HBsAg loss of ≥1.1 μg IU / mL at 24 weeks of IFN therapy compared with patients with HBsAg <1 μg / Patients can be combined with adefovir dipivoxil to improve the rate of sustained virological response.