恩替卡韦联合聚乙二醇干扰素 α-2a 治疗慢性乙型肝炎的临床疗效. (Chinese)

Curative Effect of Entecavir Combined with Polyethylene Glycol Interferon α-2a on the Patients with Chronic Hepatitis B. (English)

Objective: To explore the curative effect of entecavir combined with polyethylene glycol interferon α-2a on the patients with chronic hepatitis B. Methods: 80 patients with chronic hepatitis B were enrolled in our hospital from January 2012 to October 2015, they were randomly divided into two groups, the control group (n=40) accepted polyethylene glycol interferon α-2a treatment, and the combination group (n=40) adopted entecavir based on the patients in control group. The curative effect of patients at 12 month after treatment and the changes of clinical indicators during that treatment were compared between two groups, the changes of Th cell immune response of all patients before and after treatment were compared. Results: The total clinical efficiency of combination group at 12 month after treatment (95.0%) was significantly higher than that of the control group (70.0%) (P<0.05); At 1 month after treatment, the ALT normalization rate of combination group (22.5%, 50.0%, 67.5%, 87.5%) were higher than those of the control group (5.0%, 20.0%, 42.5%, 62.5%)(P<0.05); At 3 month after treatment, the HBV DNA negative conversion rate of patients in combination group (45.0%, 80.0%, 90.0%) were remarkably higher than those of the control group (17.5%, 45.0%, 55.0%) (P<0.05). At 6 month after treatment, the HBeAg negative conversion rate of combination group (52.5%, 72.5%) was significantly higher than those of the control group (30.0%, 50.0%) (P<0.05). The difference of HbeAg sero-conversion rate showed no significant difference between two groups (P>0.05). At 1 month after treatment, the CD3⁺CD4⁺IFN-γ⁺ of both groups were significantly decreased than those before treatment (P<0. 05), and the CD3⁺CD4⁺IL-4⁺ of control group increased at 3 month after treatment, and which was increased at 6 month after treatment in the combination group (P<0.05). At 1 month after treatment, the CD3⁺CD4⁺IFN-γ⁺ of patients in combination group (36.7± 8.2, 34.8± 7.9, 32.1± 7.5, 23.7± 7.3) were significantly higher than those of the control group (34.2± 7.6, 31.4± 8.2, 29.3± 8.1, 19.8± 7.7)(P<0. 05), and at 6 month after treatment, the CD3⁺CD4⁺IL-4⁺ of patients in combination group (0.7± 0.4, 1.1± 0.2) were significantly higher than those of the control group (0.9± 0.3, 1.3± 0.6) (P<0.05). Conclusions: Entecavir combined with polyethylene glycol interferon α-2a had remarkable curative effect for patients with chronic hepatitis B, which not only inhibited the HBV copy, but also eliminated HBV through synergistic antiviral effect via regulation Th cell immune response [ABSTRACT FROM AUTHOR]

目的：探讨恩替卡韦联合聚乙二醇干扰素α-2a治疗慢性乙型肝炎的临床疗效以及对患者外周血Th1 及Th2 细胞比值的影 响。方法：选择2012 年1 月至2015 年10 月在我院进行治疗的慢性乙型肝炎患者80例，将其随机分为两组，每组40 例。对照组 患者接受聚乙二醇干扰素α-2a 治疗，联合组在对照组基础上服用恩替卡韦，比较两组患者治疗12 个月后的临床疗效、治疗期间 临床相关指标的变化以及治疗前后机体Th 细胞免疫应答的变化情况。结果：联合组患者治疗12 个月的临床疗效总有效率 (95.0%)显著高于对照组(70.0%)(P<0.05)，治疗1 个月后ALT 复常率(22.5%，50.0%，67.5%，87.5%)显著高于对照组(5.0%，20.0%， 42.5%，62.5%)(P<0.05)，治疗3 个月后血清HBV DNA 转阴率(45.0%，80.0%，90.0%)显著高于对照组(17.5%，45.0%，55.0%)(P<0. 05)，治疗6 个月后HBeAg转阴率(52.5%，72.5%)显著高于对照组(30.0%，50.0%)(P<0.05)。治疗期间，两组患者的HbeAg血清转换 率比较差异无统计学意义(P>0.05)。两组患者治疗1 个月后外周血CD3⁺CD4⁺IFN-γ⁺较治疗前均显著降低(P<0.05)，对照组 CD3⁺CD4⁺IL-4⁺在治疗3 个月后显著上升(P<0.05)，联合组则在治疗6 个月后显著上升(P<0.05)； 而联合组患者在治疗1 个月后 CD3⁺CD4⁺IFN-γ⁺(36.7± 8.2，34.8± 7.9，32.1± 7.5，23.7± 7.3)显著高于对照组(34.2± 7.6，31.4± 8.2，29.3± 8.1，19.8± 7.7)(P<0.05)， 联合组治疗后6 个月CD3⁺CD4⁺IL-4⁺(0.7± 0.4，1.1± 0.2)则显著低于对照组(0.9± 0.3，1.3± 0.6)(P<0.05)。结论：恩替卡韦联合聚乙 二醇干扰素琢-2a 治疗慢性乙型肝炎的临床疗效显著，可有效抑制HBV复制，可能通过调控Th 细胞免疫应答，协同抗病毒效应， 从而清除HBV。 [ABSTRACT FROM AUTHOR]

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