Interferon α treatment and retreatment of hepatitis B e antigen-negative chronic hepatitis B
Interferon α treatment and retreatment of hepatitis B e antigen-negative chronic hepatitis B
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DOI：
10.1053/gast.2001.25524
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发表时间：
2001-07-01
期刊：
影响因子：
29.4
通讯作者：
Hadziyannis, SJ
中科院分区：
文献类型：
--
作者：
Manesis, EK;Hadziyannis, SJ
背景与目的：在乙型肝炎e抗原（HBeAg）阴性的慢性乙型肝炎（CHBe-）中，干扰素（IFN）的生化持续应答率非常低。没有关于再处理的资料。方法：对216例CHBe患者进行回顾性分析，这些患者接受3 μ ifn - α 2b治疗5或12个月，每周3次，因无反应或复发而撤退（51例，60个疗程）。结果：中位随访7年后，39例（18.1%）患者在单次干扰素治疗后仍处于生化和病毒学缓解期。多变量分析显示，较长的治疗时间和4个月内的生化反应是显著的预测因子，与复发呈负相关（相对危险度[RH]， 0.611； 95%可信区间[CI]， 0.448-0.834；相对危险度[RH]， 0.290; 95% CI, 0.192-0.438）。通过意向治疗，再治疗导致18.4%的持续缓解（98例患者中有18例）。持续缓解的患者丙氨酸转氨酶水平持续正常，分子杂交检测不到乙型肝炎病毒（HBV） DNA，组织学分级明显改善，32%的患者乙型肝炎表面抗原消失。在持续应答者中，通过定量聚合酶链反应，在治疗结束和随访结束时血清HBV DNA检测不到或非常低（中位数分别为3934和903拷贝/mL）。结论：IFN在大约18%的初发或复发CHBe-患者中诱导了长期生化和病毒学缓解。持续应答者表现出显著的组织学改善和高HBsAg损失率。
Background & Aims: In hepatitis B e antigen (HBeAg)negative chronic hepatitis B (CHBe-), interferon (IFN) achieves very low biochemical sustained response rates. No information exists on retreatment. Methods: Two hundred sixteen CHBe- patients treated for 5 or 12 months with 3 MU IFN-alpha 2b thrice weekly and retreated (51 patients, 60 courses) because of no response or relapse were retrospectively analyzed. Results: After 7.0 years of median follow-up, 39 naive patients (18.1%) were still in biochemical and virologic remission after a single IFN course. Longer treatment and a biochemical response within 4 months were significant predictors, inversely related to relapse by multivariate analysis (relative hazard [RH], 0.611; 95% confidence interval [CI], 0.448-0.834 and RH, 0.290; 95% CI, 0.192-0.438, respectively). Retreatment resulted in 18.4% sustained response by intention-to-treat (18 of 98 patients). Patients with sustained response had persistently normal alanine aminotransferase levels, undetectable hepatitis B virus (HBV) DNA by molecular hybridization, and significant improvement of histologic grade, and 32% of them lost hepatitis B surface antigen. In sustained responders, serum HBV DNA was undetectable or very low at the end of treatment and at the end of follow-up (median 3934 and 903 copies/mL, respectively) by quantitative polymerase chain reaction. Conclusions: IFN induced long-term biochemical and virologic remission in approximately 18% of naive or retreated patients with CHBe-. Sustained responders exhibited significant histologic improvement and a high rate of HBsAg loss.