Luo X D, Chen X P, Chen X F
Department of Infectious Diseases, Guangdong Academy of Medical Science, Guangdong General Hospital, Guangzhou 510000, China.
Zhonghua Gan Zang Bing Za Zhi. 2017 Aug 20;25(8):583-588. doi: 10.3760/cma.j.issn.1007-3418.2017.08.006.
To investigate the clinical effect of 156-week telbivudine sequential therapy in HBeAg-positive chronic hepatitis B patients with suboptimal response to pegylated interferon-α-2a (Peg-IFN-α-2a) therapy. A total of 35 HBeAg-positive CHB patients with HBV DNA < 500 IU/ml who were treated with Peg-IFN-α-2a for 48 weeks and did not experience seroconversion of HBeAg were given telbivudine sequential therapy for 156 weeks. HBeAg clearance rate, HBeAg seroconversion rate, HBV DNA clearance rate, safety, and drug resistance rate were analyzed. The t-test was used for the analysis of continuous data and the chi-square test was used for the analysis of categorical data. A multivariate Cox regression analysis was used to identify the influencing factors for HBeAg seroconversion. Telbivudine sequential therapy achieved an ideal HBeAg seroconversion rate of 87.88% with good tolerability and low drug resistance. The HBeAg clearance rate and HBeAg seroconversion rate increased over the time of treatment and were 45.45% and 45.45%, respectively, at 24 weeks and 93.94% and 87.88%, respectively, at 156 weeks. No patient had virologic breakthrough or HBsAg clearance during treatment. The multivariate Cox regression analysis showed that baseline HBsAg level (hazard ratio [] = 0.404, = 0.003) and > 0.5 lg IU/ml reduction in HBeAg at 24 weeks ( = 2.196, = 0.048) were predictive factors for HBeAg seroconversion at 156 weeks. In HBeAg-positive CHB patients with suboptimal response to Peg-IFN-α-2a therapy, 156-week telbivudine sequential therapy has a good clinical effect and can be used as an optimal regimen for such patients.
探讨替比夫定156周序贯疗法对聚乙二醇化干扰素α-2a（Peg-IFN-α-2a）治疗应答欠佳的HBeAg阳性慢性乙型肝炎患者的临床疗效。选取35例HBeAg阳性慢性乙型肝炎患者，其HBV DNA<500 IU/ml，接受Peg-IFN-α-2a治疗48周后HBeAg未发生血清学转换，给予替比夫定序贯治疗156周。分析HBeAg清除率、HBeAg血清学转换率、HBV DNA清除率、安全性及耐药率。连续数据采用t检验分析，分类数据采用卡方检验分析。采用多因素Cox回归分析确定HBeAg血清学转换的影响因素。替比夫定序贯疗法达到了理想的HBeAg血清学转换率87.88%，耐受性良好且耐药率低。HBeAg清除率和HBeAg血清学转换率在治疗过程中逐渐升高，24周时分别为45.45%和45.45%，156周时分别为93.94%和87.88%。治疗期间无患者发生病毒学突破或HBsAg清除。多因素Cox回归分析显示，基线HBsAg水平（风险比[]=0.404，=0.003）和24周时HBeAg下降>0.5 lg IU/ml（=2.196，=0.048）是156周时HBeAg血清学转换的预测因素。对于Peg-IFN-α-2a治疗应答欠佳的HBeAg阳性慢性乙型肝炎患者，替比夫定156周序贯疗法具有良好的临床疗效，可作为此类患者的优化治疗方案。
