Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan.
J Gastroenterol. 2012 Jul;47(7):814-22. doi: 10.1007/s00535-012-0548-5. Epub 2012 Feb 24.
Few studies have investigated the long-term effects of interferon (IFN) therapy for chronic hepatitis B (CHB). In this retrospective study, we investigated the efficacy of and predictors of response to IFN therapy in CHB patients.
We analyzed data for 615 Japanese CHB patients (hepatitis B e antigen [HBeAg]-positive 414, HBeAg-negative 201) treated with IFN, and conducted follow up for a median duration of 8.1 years (range 0.5-23.2). Responders were defined as patients who showed continuously normalized alanine transaminase (ALT) levels, HBeAg clearance, and low hepatitis B virus (HBV) DNA levels at 6 months post-treatment or for a span of more than 6 months until each test point at 1, 3, 5, and 10 years.
The IFN response rates of all patients were 21, 18, 21, 23, and 25% at 6 months and 1, 3, 5, and 10 years, respectively. On multivariate analysis, significant determinants of the outcome of IFN therapy were as follows: at 6 months and 1 year, young age, low HBV DNA levels, and long duration of treatment; at 3 years, long duration of treatment, young age, and high level of albumin; at 5 years, high level of albumin, female, and pretreated with IFN; and at 10 years, HBeAg-negative. Sixty-nine of the 615 patients (11%) achieved seroclearance of hepatitis B surface antigen (HBsAg). On multivariate analysis, age ≥30 years, HBV genotype A, and male were all independent factors predicting the achievement of HBsAg seroclearance.
HBeAg, HBV DNA level, age, sex, albumin, duration of treatment, pretreatment with IFN, and HBV genotype were important factors in determining long-term response to IFN therapy.
很少有研究调查干扰素（IFN）治疗慢性乙型肝炎（CHB）的长期效果。在这项回顾性研究中，我们调查了 IFN 治疗 CHB 患者的疗效和反应预测因素。
我们分析了 615 例接受 IFN 治疗的日本 CHB 患者（HBeAg 阳性 414 例，HBeAg 阴性 201 例）的数据，并进行了中位 8.1 年（0.5-23.2 年）的随访。应答者定义为治疗后 6 个月内持续正常丙氨酸氨基转移酶（ALT）水平、HBeAg 清除和低乙型肝炎病毒（HBV）DNA 水平，或在每个测试点 1、3、5 和 10 年的持续时间超过 6 个月的患者。
所有患者的 IFN 反应率分别为 6 个月和 1、3、5 和 10 年时的 21%、18%、21%、23%和 25%。多变量分析显示，IFN 治疗结果的显著决定因素如下：6 个月和 1 年时，年龄较小、HBV DNA 水平较低和治疗时间较长；3 年时，治疗时间较长、年龄较小和白蛋白水平较高；5 年时，白蛋白水平较高、女性和预先接受 IFN 治疗；10 年时，HBeAg 阴性。615 例患者中有 69 例（11%）实现了乙型肝炎表面抗原（HBsAg）血清清除。多变量分析显示，年龄≥30 岁、HBV 基因型 A 和男性均为预测 HBsAg 血清清除的独立因素。
HBeAg、HBV DNA 水平、年龄、性别、白蛋白、治疗时间、预先使用 IFN 和 HBV 基因型是决定 IFN 治疗长期反应的重要因素。
