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中华实验和临床感染病杂志(电子版) ›› 2016, Vol. 10 ›› Issue (02) : 146 -150. doi: 10.3877/cma.j.issn.1674-1358.2016.02.004

临床论著

HBsAg定量在慢性乙型肝炎患者干扰素抗病毒治疗中的变化及临床意义
张楠1, 颜学兵2,†(), 郝俊贵2, 张言超2   
  1. 1. 214000　无锡市，江苏省无锡市第二人民医院重症医学科
    2. 221002　徐州市；徐州医学院附属医院感染性疾病科
  • 收稿日期:2015-06-02 出版日期:2016-04-15
  • 通信作者: 颜学兵
  • 基金资助:
    国家自然科学基金项目(No. 81371867); 江苏省"科教兴卫"医学重点人才培养基金(No.RC2011117)

Changes and clinical significance of quantitative hepatitis B surface antigen in patients with chronic hepatitis B receiving interferon therapy

Nan Zhang1, Xuebing Yan2,†(), Jungui Hao2, Yanchao Zhang2   

  1. 1. Intensive Care Unit, Wuxi No.2 People’s Hospital, Wuxi 214000, China
    2. Department of Infectious Diseases, the Afflicted Hospital of Xuzhou Medical College, Xuzhou 221002, China
  • Received:2015-06-02 Published:2016-04-15
  • Corresponding author: Xuebing Yan
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张楠, 颜学兵, 郝俊贵, 张言超. HBsAg定量在慢性乙型肝炎患者干扰素抗病毒治疗中的变化及临床意义[J/OL]. 中华实验和临床感染病杂志(电子版), 2016, 10(02): 146-150.

Nan Zhang, Xuebing Yan, Jungui Hao, Yanchao Zhang. Changes and clinical significance of quantitative hepatitis B surface antigen in patients with chronic hepatitis B receiving interferon therapy[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2016, 10(02): 146-150.

目的

研究HBsAg定量在慢性乙型肝炎患者干扰素抗病毒治疗期间的变化及临床意义。

方法

收集43例接受IFN-α治疗的HBeAg阳性慢性乙型肝炎患者为研究对象。分别在治疗前和治疗后1、3和6个月时定量检测患者血清HBsAg水平；并同时监测其HBV DNA、HBeAg、HBcAb及ALT的水平。

结果

43例患者治疗前和治疗后1、3、6个月时血清HBsAg水平呈下降趋势，差异具有统计学意义（P = 0.029）；治疗1个月时较治疗前有所下降，但差异无统计学意义（t =-1.12、P = 0.304）；治疗3个月和6个月时均较治疗前显著下降，差异具有统计学意义（t =-2.71、P = 0.015，t =-2.71、P = 0.010）；其他不同时间点间比较差异均无统计学意义。IFN-α治疗6个月时患者血清HBsAg下降> 0.5 log10IU/ml组患者ALT复常率高于下降< 0.5 log10IU/ml组，差异具有统计学意义（χ2 =5.536、P = 0.019）；下降> 0.5 log10IU/ml组HBeAg阴转率高于下降< 0.5 log10IU/ml组，差异具有统计学意义（χ2 = 4.226、P = 0.040）；下降> 0.5 log10IU/ml组HBeAg血清学转换率高于下降< 0.5 log10IU/ml组，差异具有统计学意义（χ2 = 4.226、P = 0.040）。

结论

HBsAg定量在慢性乙型肝炎患者IFN-α治疗早期呈下降趋势。HBsAg定量在慢性乙型肝炎IFN-α治疗早期下降迅速的患者ALT复常率、HBeAg阴转率及HBeAg血清学转换率均高于下降缓慢者。

关键词: 表面抗原, 肝炎病毒, 乙型, 丙氨酸氨基转氨酶, e抗原, 肝炎病毒, 乙型, 血清学转换
Objective

To investigate the changes and clinical significance of quantitative hepatitis B surface antigen (HBsAg) in patients with chronic hepatitis B (CHB) receiving interferon-α (IFN-α) therapy.

Methods

Total of 43 CHB patients with HBeAg-positive who received IFN-α therapy were enrolled. The levels of serum HBsAg were detected before treatment and after 1 month, 3 months and 6 months respectively; while the levels of HBV DNA, HBeAg, HBcAb and ALT were monitored, respectively.

Results

The levels of serum HBsAg decreased during the IFN-α therpy, with significant difference (P = 0.029); the level of HBsAg at 1 month after treatment was lower than the baseline, but with no significant difference (t =-1.12, P = 0.304); the level of HBsAg at 3 and 6 months after treatment were lower than the baseline, with significant differences (t =-2.71, P = 0.015; t =-2.71, P = 0.010); there were no significant difference between other time points (P all > 0.05). After 6 months treatment, the patients with a reduction of HBsAg > 0.5 log10IU/ml achieved higher ALT normalization rate (χ2 =5.536, P = 0.019), HBeAg loss rate (χ2 = 4.226, P = 0.040) and HBeAg seroconversion rate (χ2 = 4.226, P = 0.040) than the rest patients with a reduction of HBsAg < 0.5 log10IU/ml.

Conclusions

The levels of serum HBsAg in patients with CHB decreased during IFN-α early treatment. The patients whose serum HBsAg decreased faster had higher ALT normalization rates, HBeAg loss rates and HBeAg seroconversion rates than the other ones.

Key words: Hepatitis B surface antigen, Alanine Transaminase, Hepatitis B e antigen, Seroconversion
表1 患者接受IFN-α治疗前的基线特征
指标 血清HBsAg 统计量 P值
下降> 0.5 log10IU/ml（n = 14） 下降< 0.5 log10IU/ml（n = 29）
性别（男/女）a 11/3 19/10 — 0.491
家族史（有/无） 6/8 13/16 χ2 = 0.015 0.903
年龄（±s，岁） 29.6 ± 9.8 29.4 ± 7.7 t = 0.071 0.944
ALT（±s，U/L） 126.4 ± 65.9 121.2 ± 84.7 t = 0.348 0.729
HBV DNA（±s，log10IU/ml） 6.75 ± 1.08 6.72 ± 0.99 t = 0.065 0.948
HBsAg（±s，log10IU/ml） 3.96 ± 0.55 3.81 ± 0.46 t = 0.958 0.344
HBeAg（±s，PEIU/ml） 267.74 ± 193.21 200.03 ± 177.33 t = 1.094 0.280
HBcAb（±s，S/CO） 10.73 ± 2.39 10.23 ± 2.11 t = 1.171 0.248
表2 患者接受IFN-α治疗6个月时的治疗应答[例（%）]
指标 血清HBsAg χ 2值 P值
下降> 0.5 log10IU/ml（n = 14） 下降< 0.5 log10IU/ml（n = 29）
ALT复常 12（85.7） 14（48.3） 5.536 0.019
HBV DNA低于检测下限a 5（35.7） 9（31.0） 0.000 1.000
HBeAg阴转a 6（42.9） 3（10.3） 4.226 0.040
HBeAg血清学转换a 6（42.9） 3（10.3） 4.226 0.040
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