[干扰素-α治疗后慢性乙型肝炎复发的相关因素：一项随访研究]

[Factors related to chronic hepatitis B relapse after interferon-alpha treatment: a follow-up study].

作者信息

Liu Ding-Li, Luo Kang-Xian, Feng Xiao-Rong, Fu Qun-Xiang, Hou Jin-Lin

机构信息

Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.

出版信息

Nan Fang Yi Ke Da Xue Xue Bao. 2007 Aug;27(8):1264-6, 1270.

PMID:17715044

Abstract

OBJECTIVE

To investigate the related to relapse of chronic hepatitis B (CHB) after recombinant interferon-alpha (rIFN-alpha) treatment.

METHODS

This investigation involved 523 pathologically confirmed CHB patients including 403 HBeAg-positive and 120 HBeAg-negative patients, who were treated with 5 MU rIFN-alpha subcutaneously thrice a week for 6-25 months. For each patient, serum alanine aminotransferase (ALT) was measured biochemically, serum HBV DNA level detected with quantitative fluorescent PCR, and HBeAg level with enzyme immuoassay every 1-3 months during therapy and every 3-6 months during the follow-up period.

RESULTS

Early response to rIFN-alpha treatment was observed in 302 (57.7%) patients at the end of treatment, among whom 39.4% (119/302) suffered relapse during the follow-up for 39.2-/+21.5 months. Age, HBeAg status before treatment, and follow-up duration were the predictive factors for post-treatment relapse. The mean age of patients with CHB relapse was significantly higher than that of the sustained responders (P<0.001), and the relapse rates in HBeAg-negative group (55.8%, 43/77) were significantly higher than that in HBeAg-positive group (33.8%, 76/225) at the end of follow up (P<0.001). The relapse rate and accumulative relapse rates at each year during the follow-up (for 5 years as the longest) differed significantly (P<0.001, P=0.000), but the accumulative relapse rates differed little between the years after the initial 2 of the follow-up (P=0.670). The relapse was not related to the patient's gender, pretreatment serum ALT, HBV DNA, grade of liver inflammation, stage of liver fibrosis, or duration of treatment. In HBeAg-positive patients, however, the mean HBV DNA was significantly higher in relapse group than in sustained response group (P=0.017).

CONCLUSION

Age, pretreatment HBeAg status, and follow-up duration are independent predictive factors for post-treatment CHB relapse. In HBeAg positive patients, pretreatment serum HBV DNA is also one of the risk factors for relapse.

摘要

目的

探讨重组α干扰素（rIFN-α）治疗后慢性乙型肝炎（CHB）复发的相关因素。

方法

本研究纳入523例经病理确诊的CHB患者，其中HBeAg阳性403例，HBeAg阴性120例，接受5MU rIFN-α皮下注射，每周3次，疗程6 - 25个月。治疗期间每1 - 3个月、随访期间每3 - 6个月检测每位患者的血清丙氨酸氨基转移酶（ALT）、采用荧光定量PCR检测血清HBV DNA水平、采用酶免疫法检测HBeAg水平。

结果

治疗结束时302例（57.7%）患者出现对rIFN-α治疗的早期应答，其中39.4%（119/302）在39.2±21.5个月的随访期间复发。年龄、治疗前HBeAg状态及随访时间是治疗后复发的预测因素。CHB复发患者的平均年龄显著高于持续应答者（P<0.001），随访结束时HBeAg阴性组的复发率（55.8%，43/77）显著高于HBeAg阳性组（33.8%，76/225）（P<0.001）。随访期间每年的复发率及累积复发率（最长随访5年）差异有统计学意义（P<0.001，P=0.000），但随访开始后第2年以后各年的累积复发率差异不大（P=0.670）。复发与患者性别、治疗前血清ALT、HBV DNA、肝脏炎症分级、肝纤维化分期或治疗疗程无关。然而，在HBeAg阳性患者中，复发组的平均HBV DNA显著高于持续应答组（P=0.017）。