基线乙肝表面抗原（HBsAg）作为聚乙二醇化干扰素-α2a和阿德福韦治疗的慢性乙型肝炎患者持续HBsAg消失的预测指标

Baseline hepatitis B surface antigen (HBsAg) as predictor of sustained HBsAg loss in chronic hepatitis B patients treated with pegylated interferon-α2a and adefovir.

作者信息

Takkenberg R Bart, Jansen Louis, de Niet Annikki, Zaaijer Hans L, Weegink Christine J, Terpstra Valeska, Dijkgraaf Marcel G W, Molenkamp Richard, Jansen Peter L M, Koot Maarten, Rijckborst Vincent, Janssen Harry L A, Beld Marcel G H M, Reesink Hendrik W

出版信息

Antivir Ther. 2013;18(7):895-904. doi: 10.3851/IMP2580.

DOI:10.3851/IMP2580

Abstract

BACKGROUND

In this study, we aimed to identify baseline predictors of response in chronic hepatitis B patients treated with a combination of pegylated interferon (PEG-IFN)-α2a and adefovir.

METHODS

We treated 92 chronic hepatitis B patients (44 hepatitis B e antigen [HBeAg]-positive and 48 HBeAg-negative) with HBV DNA > 100,000 copies/ml (> 17,182 IU/ml) with PEG-IFN and adefovir for 48 weeks and followed them up for 2 years. Baseline markers for HBeAg loss, combined response (HBeAg negativity, HBV DNA levels ≤ 2,000 IU/ml and alanine aminotransferase [ALT] normalization) and hepatitis B surface antigen (HBsAg) loss were evaluated.

RESULTS

Two years after the end of treatment, rates of HBeAg loss and HBsAg loss in HBeAg-positive patients were 18/44 (41%) and 5/44 (11%), respectively. In HBeAg-negative patients, rates of combined response and HBsAg loss were 12/48 (25%) and 8/48 (17%), respectively. HBeAg-negative patients with HBsAg loss had lower baseline HBsAg levels than those without HBsAg loss (mean HBsAg 2.35 versus 3.55 log10 IU/ml; P < 0.001). They also had lower HBV DNA levels and were more often (PEG-)IFN experienced. Baseline HBsAg was the only independent predictor of HBsAg loss (OR 0.02; P = 0.01).

CONCLUSIONS

With combination therapy of PEG-IFN and adefovir for 48 weeks, a high rate of HBsAg loss was observed in both HBeAg-positive (11%) and HBeAg-negative (17%) patients 2 years after treatment ended. In HBeAg-negative patients, a low baseline HBsAg level was a strong predictor for HBsAg loss.

摘要

背景

在本研究中，我们旨在确定接受聚乙二醇化干扰素（PEG-IFN）-α2a与阿德福韦联合治疗的慢性乙型肝炎患者的反应基线预测指标。

方法

我们对92例慢性乙型肝炎患者（44例乙肝e抗原[HBeAg]阳性和48例HBeAg阴性）进行治疗，这些患者的HBV DNA>100,000拷贝/ml（>17,182 IU/ml），给予PEG-IFN和阿德福韦治疗48周，并随访2年。评估HBeAg消失、联合反应（HBeAg阴性、HBV DNA水平≤2,000 IU/ml和丙氨酸氨基转移酶[ALT]正常化）和乙肝表面抗原（HBsAg）消失的基线标志物。

结果

治疗结束2年后，HBeAg阳性患者的HBeAg消失率和HBsAg消失率分别为18/44（41%）和5/44（11%）。在HBeAg阴性患者中，联合反应率和HBsAg消失率分别为12/48（25%）和8/48（17%）。发生HBsAg消失的HBeAg阴性患者的基线HBsAg水平低于未发生HBsAg消失的患者（平均HBsAg 2.35对3.55 log10 IU/ml；P<0.001）。他们的HBV DNA水平也较低，并且更常接受（PEG-）IFN治疗。基线HBsAg是HBsAg消失的唯一独立预测指标（OR 0.02；P = 0.01）。

结论

采用PEG-IFN和阿德福韦联合治疗48周，治疗结束2年后，HBeAg阳性（11%）和HBeAg阴性（17%）患者均观察到较高的HBsAg消失率。在HBeAg阴性患者中，低基线HBsAg水平是HBsAg消失的有力预测指标。