Efficacy of peginterferon α- 2a in treatment of chronic hepatitis B resistant to multiple nucleos( t) ide analogues
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摘要:
目的观察聚乙二醇干扰素(PEG-IFN)α-2a治疗对多种核苷和核苷酸类药物(NAs)耐药的HBe Ag阳性慢性乙型肝炎(CHB)患者的疗效。方法选取武警上海市总队医院2009年8月-2014年2月住院及门诊的对多种NAs耐药的HBe Ag阳性CHB患者120例,根据治疗方法不同将患者分为2组,每组60例。治疗组患者全部停用NAs,改用PEG-IFNα-2a治疗48周;对照组患者维持原有NAs治疗方案不变,加用PEG-IFNα-2a治疗48周。观察治疗24、48周及停药后24周时乙型肝炎血清学标志物及HBV DNA变化情况。计数资料组间比较采用χ2检验,计量资料组间比较采用t检验。结果 2组患者均取得了较为满意的疗效,治疗第24、48周及停药后24周时2组的血清HBe Ag阴转率、HBe Ag转换率、HBV DNA阴转率以及HBs Ag阴转率相比,差异均无统计学意义(P值均>0.05)。PEG-IFNα-2a治疗过程中出现的不良反应包括发热、头痛、注射部位炎症、腹泻、中性粒细胞减少、贫血及抑郁,情况均不严重。结论 PEG-IFNα-2a...
Abstract:Objective To investigate the efficacy of peginterferon alfa- 2a( PEG- IFN α- 2a) in the treatment of HBe Ag- positive chronic hepatitis B( CHB) resistant to multiple nucleos( t) ide analogues( NAs). Methods A total of 120 patients with HBe Ag- positive CHB resistant to multiple nucleos( t) ide analogues who were hospitalized or treated in the outpatient department in our hospital from August 2009 to February 2014 were randomly divided into two groups,with 60 patients in each group. The patients in the treatment group stopped NAs and were given PEG- IFNα- 2a for 48 weeks,and those in the control group received PEG- IFNα- 2a for 48 weeks in addition to the original therapeutic regimen with NAs. The changes in the serological markers of hepatitis B and HBV DNA were observed at weeks 24 and 48 of treatment and at 24 weeks after drug discontinuation. The chi- square test was used for comparison of categorical data between groups,while comporison of continuous data was mode by t test. Results The patients in both groups achieved a satisfactory outcome. The serum HBe Ag clearance rate,HBe Ag seroconversion rate,HBV DNA clearance rate,and HBs Ag clearance rate showed no significant differences between the two groups at weeks 24 and 48 of treatment and at 24 weeks after treatment( all P > 0. 05). The adverse events that occurred during PEG- IFNα- 2a treatment were pyrexia,headache,inflammation at the injection site,diarrhea,neutropenia,anemia,and depression,and the disease is not serious. Conclusion PEG- IFNα- 2a is safe and effective in the treatment of CHB resistant to multiple NAs,and the patients can convert to PEG- IFNα- 2a directly as their antiviral therapy.
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Key words:
- hepatitis B,chronic /
- antiviral agents /
- polyethylene glycols /
- interferon alfa-2a
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[1] Chinese Society of Hepatology and Chinese Society of Infectious Disea ses,Chinese Medical Association.The guidelines of prevention and treatment for chronic hepatitis B(2010 version)[J].J Clin Hepatol,2011,27(1):Ⅰ-ⅩⅥ.(in Chinese)中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2010年版)[J].临床肝胆病杂志,2011,27(1):Ⅰ-ⅩⅥ. [2] Chinese Society of Hepatology and Chinese Society of Infectious Diseases,Chinese Medical Association.The guidelines of prevention and treatment for chronic hepatitis B[J].J Clin Hepatol,2006,22(1):3-15.(in Chinese)中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南[J].临床肝胆病杂志,2006,22(1):3-15. [3] Experts Attending the Discussion on Hepatitis B Virus Drug Resistance.Development and management of drug resistance to nucleoside/nucleotide analogues in patients with chronic hepatitis B[J].JClin Hepatol,2013,29(1):10-17.(in Chinese)参加乙型肝炎病毒耐药讨论会专家.核苷和核苷酸类药物治疗慢性乙型肝炎的耐药及其管理[J].临床肝胆病杂志,2013,29(1):10-17. [4] YANG DH,ZHAO NF,PAN HY,et al.Tenofovir rescue therapy for chronic B patients after multiple treatment failures[J].Chin JHepatol,2015,23(1):75-76.(in Chinese)杨丹红,赵年丰,潘红英,等.替诺福韦酯挽救治疗核苷(酸)类药物多重耐药慢性乙型肝炎患者的疗效观察[J].中华肝脏病杂志,2015,23(1):75-76. [5]SONG MN,HUANG WQ,MIN F.Outcomes of nucleoside analogue-based salvage therapy in patients with multidrug-resistant chronic hepatitis B[J].J Clin Hepatol,2013,29(8):600-602.(in Chinese)宋闽宁,黄文琪,闵峰.核苷类似物治疗慢性乙型肝炎产生多重耐药患者的挽救治疗观察[J].临床肝胆病杂志,2013,29(8):600-602. [6]CHOI K,LEE HM,JUN BG,et al.Efficacy of tenofovir-based rescue therapy for patients with drug-resistant chronic hepatitis B[J].Korean J Gastroenterol,2015,65(1):35-42. [7]LEE YB,JUNG EU,KIM BH,et al.Tenofovir monotherapy versus tenofovir plus lamivudine or telbivudine combination therapy in treatment of lamivudine-resistant chronic hepatitis B[J].Antimicrob A-gents Chemother,2015,59(2):972-978. [8]LEE YB,LEE JH,LEE DH,et al.Efficacy of entecavir-tenofovir combination therapy for chronic hepatitis B patients with multidrug-resistantstrains[J].Antimicrob Agents Chemother,2014,58(11):6710-6716. [9]SUN J,HOU JL,XIE Q,et al.Randomised clinical trial:efficacy of peginterferon alfa-2a in HBeA g positive chronic hepatitis B patients with lamivudine resistance[J].J Hepatol,2011,34(4):424-431. [10]SUH DJ,LEE HC,BYUN KS,et al.Efficacy and safety of pegylated interferon-α2a in patients with lamivudine-resistant HBeA g-positive chronichepatitis B[J].Antivir Ther,2013,18(6):765-773. [11]MANGANO C,SQUADRITO G,CACCIOLA I,et al.Effectiveness of add-on pegylated interferon alfa-2a therapy in a lamivudinetreated patient with chronic hepatitis B[J].Ann Hepatol,2011,10(1):84-87. [12]LAU GK,PIRATVISUTH T,LUO KX,et al.Peginterferon alfa-2a,lamivudine,and the combination for HBeA g-positive chronic hepatitis B[J].N Engl J Med,2005,352(26):2682-2695. [13]PIRATVISUTH T,LAU G,CHAO YC,et al.Sustained response to peginterferon alfa-2a(40kD)with or without lamivudine in asian patients with HBeA g-positive and HBeA g-negative chronic hepatitis B[J].Hepatol Int,2008,2(1):102-110. [14]MARCELLIN P,LAU GK,BONINO F,et al.Peginterferon alfa-2a alone,lamivudine alone,and the two in combination in patients with HBeA g-negative chronic hepatitis B[J].N Engl J Med,2004,351(12):1206-1217. [15]MARCELLIN P,BONINO F,LAU GK,et al.Sustained response of hepatitis B e antigen-negative patients 3 years after treatment with peginterferon alpha-2a[J].Gastroenterology,2009,136(7):2169-2179. [16]YANG L,YANG Y,CHEN ZY,et al.Efficacy of pegylated interferon alpha-2a in treatment of chronic hepatitis B with a wide variety of nucleos(t)ide unalogues resistance[J].The J Pract Med,2014,30(3):503-504.(in Chinese)杨龙,杨阳,陈志勇,等.聚乙二醇干扰素α-2a治疗多种核苷(酸)类药物耐药慢性乙型肝炎的疗效[J].实用医学杂志,2014,30(3):503-504. [17]XUE R.Treatment of a chronic hepatitis B patients with multi-drug resistance by peginterferon alfa-2a:a case report[J].Chin J Viral Dis,2011,1(6):450.(in Chinese)薛蓉.聚乙二醇干扰素α-2a成功治疗1例乙型肝炎多重耐药患者[J].中国病毒病杂志,2011,1(6):450. [18]ZHANG JD.Pegylated interferon in treatment of chronic hepatitis B:a report of one case[J].West China Med J,2013,28(8):1198-1199.(in Chinese)张敬东.聚乙二醇干扰素挽救治疗慢性乙型肝炎双重耐药一例[J].华西医学,2013,28(8):1198-1199. [19]ZHU SS,DONG Y,GAN Y,et al.Addition of pegylated interferonα-2a after multidrug resistance to nucleos(t)ide analogues in patients with chronic hepatitis B:a clinical analysis of 8 cases[J].Chinese J Exp Clin Virol,2012,26(6):497-498.(in Chinese)朱世殊,董漪,甘雨,等.慢性乙型肝炎患者核苷(酸)类似物多药耐药后加用聚乙二醇干扰素α-2a治疗8例临床分析[J].中华实验和临床病毒学杂志,2012,26(6):497-498.
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