核苷类经治低水平HBsAg阳性代偿期乙型肝炎肝硬化患者联合聚乙二醇干扰素α-2b疗效及安全性分析

摘要/Abstract

摘要： 目的探讨聚乙二醇干扰素α-2b(Peg-IFN-α-2b)治疗低水平HBsAg阳性代偿期乙型肝炎肝硬化患者(核苷类经治)的疗效,并分析安全性。方法选取2018年7月—2022年5月间我院就诊的代偿期乙型肝炎肝硬化患者(核苷类经治)为研究对象,选择HBsAg定量值低于1500 IU/mL患者共84例,分为单药组42例和联合组42例。联合组采用聚乙二醇干扰素α-2b联合核苷类药物,单药组继续核苷类药物治疗,疗程均为48周,对比两组患者ALT、TBil、HBsAg定量值、HBsAg转阴率、HBsAg血清转换率,并监测药物不良反应情况。结果 24周联合组和单药组ALT分别为(76.6±34.3)、(36.2±13.9)U/L,差异有统计学意义(P<0.05);联合组24、48周HBsAg定量值分别为(482.8±317.2)、(258.8±227.9)U/L,均低于单药组[(661.7±494.5)、(628.1±466.2)U/L],差异有统计学意义(P<0.01);24周联合组6例(14.3%)患者实现HBsAg清除,明显高于单药组(χ²=6.462,P=0.011),48周升至38.1%,明显高于单药组(χ²=22.909,P<0.01);48周联合组HBsAg血清转换率为23.8%,与单药组比较差异有统计学意义(χ²=11.351,P<0.01)。不良反应方面,联合组在治疗初期出现白细胞、血小板降低,但仍可耐受,继续治疗后逐渐回升,均可完成48周疗程。结论 Peg-IFN-α-2b治疗低水平HBsAg阳性代偿期乙型肝炎肝硬化患者(NA经治),在HBsAg清除率、HBsAg血清学转换方面具有明显优势,且患者耐受性较好,未出现严重不良反应。

关键词: 聚乙二醇干扰素α-2b, 乙型肝炎肝硬化, HBsAg清除, 治疗

Abstract: Objective To explore the efficacy of pegylated interferon α-2b therapy in the treatment of low serum level of hepatitis B surface antigen (HBsAg) and compensated hepatitis B-related cirrhosis patients treated with nucleosides, and to analyze the safety. Methods From July 2018 to May 2022, eighty-four patients with compensated hepatitis B-related cirrhosis treated with nucleosides were selected and divided into a single drug group and a combination group. The combination group was treated with pegylated interferon α -2b combined with nucleosides, and the single drug group continued to treat with nucleosides for 48 weeks. The levels of alanine aminotransferase (ALT), total bilirubin (TBil), and HBsAg, HBsAg seroconversion rate, and negative conversion rate of HBsAg were compared between the two groups. The adverse drug reactions in both groups of patients were monitored. Results The ALT values at 24 weeks for the combination group and monotherapy group were (76.6±34.3) and (36.2±13.9) U/L, respectively, showing a significant difference (P<0.05). The quantitative HBsAg levels at 24 weeks and 48 weeks for the combination group were (482.8±317.2) and (258.8±227.9) U/L, respectively, both were lower than those of [(661.7±494.5) and (628.1±466.2) U/L] in the monotherapy group, with statistically significant differences (P<0.01). At 24 weeks, 6 patients (38.1%) in the combination group achieved HBsAg clearance, which was significantly higher than that of the monotherapy group (χ²=6.462, P=0.011). At 48 weeks, the rate increased to 38.1%, which was still significantly higher than that of the monotherapy group (χ²=22.909, P<0.01). The HBsAg seroconversion rate at 48 weeks in the combination group was 23.8%, which was significantly different from that of the monotherapy group (χ²=11.351, P<0.01). Regarding adverse reactions, the combination group experienced a reduction in white blood cells and platelets during the early stage of treatment, but these were tolerable, and they gradually recovered with continued treatment. All patients were able to complete the 48-week treatment regimen. Conclusion Peg-IFN-α-2b treatment in low-level HBsAg compensated HBV cirrhosis patients previously treated with NAs showed significance in HBsAg clearance rate and HBsAg serological conversion, with good tolerability and without severe adverse events in patients.

Key words: Peginterferon α-2b, Hepatitis B related cirrhosis, HBsAg clearance, Therapy

代雪枫, 丁体龙, 丁烨莹, 马艳春. 核苷类经治低水平HBsAg阳性代偿期乙型肝炎肝硬化患者联合聚乙二醇干扰素α-2b疗效及安全性分析[J]. 肝脏, 2025, 30(7): 926-929.

DAI Xue-feng, DING Ti-long, DING Ye-ying, MA Yan-chun. An evaluation on the efficacy and safety of peginterferon α-2b in nucleoside-treated patients with low serum level of HBsAg and compensated hepatitis B-related cirrhosis[J]. Chinese Hepatolgy, 2025, 30(7): 926-929.

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