目的 觀察聚乙二醇干擾素α-2a聯(lián)合阿德福韋酯治療HBeAg陰性慢性乙型肝炎的臨床療效.方法 沭陽(yáng)縣中心醫(yī)院2011年1月—2013年1月收治的HBeAg陰性慢性乙型肝炎130例,隨機(jī)分為干擾素組(43例),阿德福韋酯組(39例)和聯(lián)合治療組(48例).干擾素組皮下注射聚乙二醇干擾素α-2a注射液180 μg,每周1次.阿德福韋酯組口服阿德福韋酯片10 mg/次,1次/d.聯(lián)合治療組同時(shí)給予聚乙二醇干擾素α-2a注射液和阿德福韋酯片,用法用量同以上兩組.3組患者均連續(xù)治療48周.觀察3組患者丙氨酸氨基轉(zhuǎn)移酶(ALT)復(fù)常情況、HBsAg清除情況、HBV DNA轉(zhuǎn)陰情況.結(jié)果 治療24、48、72周,干擾素組、阿德福韋酯組的HBsAg清除率、HBV DNA轉(zhuǎn)陰率均顯著低于聯(lián)合治療組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05).3組治療后ALT、HBV DNA拷貝數(shù)、HBsAg水平均較治療前顯著降低,同組治療前后差異有統(tǒng)計(jì)學(xué)意義(P<0.05);且干擾素組、阿德福韋酯組患者ALT在治療48、72周時(shí)均高于聯(lián)合治療組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05);兩組HBV DNA拷貝數(shù)從治療24周起就高于聯(lián)合治療組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05);干擾素組HBsAg水平在治療24周、48、72周時(shí)均高于聯(lián)合治療組,而阿德福韋酯組HBsAg水平僅在治療48周時(shí)高于聯(lián)合治療組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05).結(jié)論 聚乙二醇干擾素α-2a聯(lián)合阿德福韋酯治療HBeAg陰性慢性乙型肝炎具有較好的臨床療效,兩藥有一定的協(xié)同作用,優(yōu)于兩藥單獨(dú)應(yīng)用.

Objective To investigate the clinical effect of peginterferon α-2a combined with adefovir dipivoxil in treatment of HBeAg negative chronic hepatitis B. Methods Patients (130 cases) with HBeAg negative chronic hepatitis B who came to Shuyang County Central Hospital from January 2011 to January 2013 were randomly divided into interferon (43 cases), adefovir dipivoxil (39 cases) and combined treatment (48 cases) groups. The patients in the interferon group were sc administered with Peginterferon α-2a Injection (180 μg), once one week. The patients in the adefovir dipivoxil group were po administered with Adefovir Dipivoxil Tablets, 10 mg/time, once daily. The patients in the combined treatment group were given Peginterferon α-2a Injection and Adefovir Dipivoxil Tablets, and the usage and dosage were the same as the above two groups. The patients in the three groups were treated for 48 weeks. The situation of ALT return to normal, HBsAg clearance, and HBV DNA overcast in three groups were observed. Results After treatment for 24, 48, and 72 weeks, the rates of HBsAg clearance and HBV DNA overcast in interferon and adefovir dipivoxil groups were significantly lower than those in the combination treatment group, with significant difference (P < 0.05). After treatment, the levels of ALT, HBV DNA copies, and HBsAg in three groups were significantly reduced, and the differences were statistically significant before and after treatment (P < 0.05). ALT in interferon and adefovir dipivoxil groups were higher than that in the combination treatment group with the significant difference (P < 0.05) in the treatment of 48 weeks and 72 weeks. HBV DNA copies in two groups were higher than that in the combined treatment group from the treatment of 24 weeks, and the difference was statistically significant (P < 0.05). HBsAg level in the interferon group was higher than that in the combination treatment group, with significant difference (P < 0.05) in the treatment of 24, 48, and 72 weeks. While HBsAg level in the adefovir dipivoxil group was higher than that in the combined treatment group only in the treatment of 48 weeks with the significant difference (P < 0.05). Conclusion Peginterferon α-2a combined with adefovir dipivoxil has a good clinical efficacy in the treatment of HBeAg negative chronic hepatitis B, and the two drugs have a certain synergy, which is better than that of two drug used alone.