Flink Hajo J, van Zonneveld Monika, Hansen Bettina E, de Man Robert A, Schalm Solko W, Janssen Harry L A
Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
Am J Gastroenterol. 2006 Feb;101(2):297-303. doi: 10.1111/j.1572-0241.2006.00418.x.
Hepatitis B surface antigen (HBsAg) loss is the hallmark of a complete response to antiviral therapy for chronic hepatitis B. In this study, we investigated the frequency of HBsAg loss after treatment with pegylated (Peg)-interferon alpha-2b.
In a multicenter randomized controlled trial, 266 HBeAg-positive patients were treated for 52 wks with Peg-interferon alpha-2b (100 microg/wk) in combination with either lamivudine (100 mg/day) or placebo. Posttreatment follow-up was 26 wks.
At the end of follow-up, 95 (36%) of the 266 patients exhibited HBeAg loss, 18 (7%) HBsAg loss, and 16 (6%) HBsAg seroconversion. Addition of lamivudine did not enhance HBeAg loss, HBsAg loss, or development of anti-HBs. All 18 patients who showed HBsAg loss had normal ALT; 11 (61%) of these patients were also hepatitis B virus (HBV) DNA negative (<400 copies/mL) at the end of follow-up. Loss of HBsAg differed according to HBV genotype: 14% for genotype A, 9% for genotype B, 3% for genotype C, and 2% for genotype D (A vs D: p = 0.006).
One year of Peg-interferon alpha-2b for HBeAg-positive patients led to HBsAg loss in 7%. Our study indicates that treatment with Peg-interferon alpha-2b is the best therapy to achieve HBsAg clearance in patients with genotype A.
乙肝表面抗原（HBsAg）消失是慢性乙型肝炎抗病毒治疗完全应答的标志。在本研究中，我们调查了聚乙二醇化（Peg）干扰素α-2b治疗后HBsAg消失的频率。
在一项多中心随机对照试验中，266例HBeAg阳性患者接受Peg干扰素α-2b（100μg/周）联合拉米夫定（100mg/天）或安慰剂治疗52周。治疗后随访26周。
随访结束时，266例患者中有95例（36%）出现HBeAg消失，18例（7%）出现HBsAg消失，16例（6%）出现HBsAg血清学转换。添加拉米夫定并未增强HBeAg消失、HBsAg消失或抗-HBs的产生。所有18例出现HBsAg消失的患者ALT均正常；其中11例（61%）患者在随访结束时乙肝病毒（HBV）DNA也呈阴性（<400拷贝/mL）。HBsAg消失情况因HBV基因型而异：A型为14%，B型为9%，C型为3%，D型为2%（A与D比较：p=0.006）。
HBeAg阳性患者接受一年的Peg干扰素α-2b治疗后，7%的患者出现HBsAg消失。我们的研究表明，Peg干扰素α-2b治疗是实现A型基因型患者HBsAg清除的最佳疗法。
