The combination therapy of Peginterferonα and entecavir for HBeAg-positive chronic hepatitis B with high HCC risk.
The combination therapy of Peginterferonα and entecavir for HBeAg-positive chronic hepatitis B with high HCC risk.
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DOI：
10.1016/j.meegid.2019.104101
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发表时间：
2020-03
期刊：
影响因子：
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通讯作者：
F. Xiong;Xuli Bao;Na Gu;Jia Guo;Jinhuan Wang;Yanpin Ma;Lele Yu;Yao Gao;Bingqin Tan;Jun Lu
中科院分区：
文献类型：
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作者：
F. Xiong;Xuli Bao;Na Gu;Jia Guo;Jinhuan Wang;Yanpin Ma;Lele Yu;Yao Gao;Bingqin Tan;Jun Lu
有肝细胞癌(HCC)家族史的HBV感染人群是发生HCC的高危人群。本研究的目的是评估包括聚乙二醇化干扰素 α-2a (PEG-IFNα-2a) 和恩替卡韦 (ETV) 在内的新组合疗法在这一高危人群中的效果。该研究招募了 58 名乙型肝炎 e 抗原（HBeAg）阳性的 CHB 患者，这些患者的 HBV-DNA > 107IU/mL、基因型 B 或 C、有 HCC 家族史，并接受治疗 48 周。第 48 周 HBeAg 未消失的患者为 40 名，并将联合治疗延长至 96 周。所有患者均接受长达 120 周的随访。 120周时HBeAg消失率和HBsAg消失率分别为12/40（30.0%）和2/40（5.0%）。当使用逻辑回归分析来确定 HBeAg 消失的可行性时，发现第 48 周时 HBV-DNA 水平 <20IU/mL 的 HBeAg 消失概率增加了 6.02 倍 (95% CI=1.17–30.40，P=.03)。 48周时HBV-DNA水平<20IU/mL的患者HBeAg消失的概率较高，为8/17（47.1%），HBsAg消失的概率为2/17（11.8%），而HBV-DNA≥20IU/mL的患者为4/23（17.4%）和0/23（0%）。 96周的联合治疗耐受性良好。在联合治疗期间，治疗期间的低水平病毒血症与反应呈负相关。建议PEG-IFNα和ETV联合治疗延长至96周，待第48周时HBV-DNA完全抑制。
The population of HBV infection with family history of hepatocellular carcinoma (HCC) is the high risk group for the development of HCC. The aim of this study was to evaluate the effect of thede novocombination therapy including pegylated-interferon α-2a (PEG-IFNα-2a) and entecavir (ETV) in this high risk population. The study recruited 58 Hepatitis B e Antigen (HBeAg)-Positive CHB patients patients with HBV-DNA > 107IU/mL, genotype B or C and HCC family history and were treated for 48 weeks. Patients without HBeAg loss at the 48th week were 40 patients and extended the combination therapy to 96 weeks. All patients were followed up to 120 weeks. The rate of HBeAg loss and HBsAg loss was 12/40(30.0%) and 2/40(5.0%) at week 120 respectively. When logistic regression analysis was used to identify viables of HBeAg loss, HBV-DNA levels <20 IU/mL at week 48 was found to have a 6.02 fold increased probability (95% CI = 1.17–30.40,P= .03) of HBeAg loss. Patients with HBV-DNA levels <20 IU/mL at week 48 had a high probability of HBeAg loss 8/17(47.1%), HBsAg loss 2/17(11.8%), compared to 4/23(17.4%), 0/23(0%) in patients with HBV-DNA ≥ 20 IU/mL. Combination therapy for 96 weeks was well tolerated. During the combination therapy, low-level viremia during treatment is reversely associated with response. The combination therapy of PEG-IFNα and ETV was suggested to extend to 96 weeks when HBV-DNA was completed suppressed at week 48.