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目的研究干扰素联合核苷类似物对HBsAg,HBeAg定量影响的平台效应。方法采用化学发光法检测134例CHB患者HBsAg,HBeAg定量,用SPSS 19.0软件包进行统计学处理。结果 134例乙型肝炎患者治疗后,126例HBsAg定量下降,降幅<30%31例、30%~50%21例、51%~80%36例、>80%38例;上升7例;无变化1例74例HBeAg定量下降,降幅<30%2例、30%~50%12例、51%~80%9例、>80%51例;上升8例,其中1例小三阳变为大三阳;无变化52例。HBeAg阳性CHB组1例HBsAg转阴,HBeAg转阴率32.09%(26/81);HBeAg阴性CHB组HBsAg转阴率7.55%(4/53)。HBeAg阳性CHB治疗前后HBsAg定量分别(27 104.07±32 642.11)IU/mL,(12 263.37±19 037.3)IU/mL,降幅(51±39)%;HBeAg定量分别(1600.86±2796.52)CI,(445.0±1 245.39)CI,降幅(60±95)%。HBeAg阴性CHB治疗前后HBsAg定量分别(4926.3±6607.88)IU/mL,(2565.77±4110.57)IU/mL,降幅(54±42)%。HBeAg阴性CHB组HBsAg,HBeAg定量反弹率66.03%(35/53),反弹1,2,3,4,5,6次以上分别11,14,7,2,0,1例,共反弹75例次。HBeAg阳性CHB组HBsAg,HBeAg定量反弹率85.18%(69/81),反弹1,2,3,4,5,6次分别26,16,12,8,5,2例,共反弹163例次,总反弹238例次。反弹有4种模式,HBsAg,HBeAg同时上升型常与HBV DNA控制不佳有关;HBsAg下降,HBeAg上升型可向前者转化;HBeAg下降HBsAg上升型,HBeAg稳定HBsAg上升型更多见。结论干扰素联合核苷(酸)类似物治疗CHB是目前较理想的方案,延长疗程对HBeAg尤其HBsAg转阴并无突破;治疗过程中HBsAg,HBeAg定量频发反弹现象,平台效应与CHB难治直接相关,及时发现并明确反弹原因,积极采取有效措施,不断优化治疗可望减少反弹并打破平台效应,提高CHB治疗效果。
Objective To study the effect of interferon combined with nucleoside analogues on the quantitative effect of HBsAg and HBeAg on plateau. Methods Quantitative determination of HBsAg and HBeAg in 134 CHB patients by chemiluminescence method was performed with SPSS 19.0 software package for statistical analysis. Results After the treatment of 134 patients with hepatitis B, 126 cases of HBsAg decreased quantitatively, with a decrease of <30% in 31 cases, 30% ~ 50% in 21 cases, 51% ~ 80% in 36 cases and> 80% in 38 cases; In one case, 74 patients had a decrease of HBeAg, with a decrease of <30% in 2 cases, 30% ~ 50% in 12 cases, 51% ~ 80% in 9 cases and> 80% in 51 cases; Sanyang; no change in 52 cases. In HBeAg-positive CHB group, one case of HBsAg was negative, the negative rate of HBeAg was 32.09% (26/81), while the negative rate of HBsAg in HBeAg-negative CHB group was 7.55% (4/53). The HBsAg levels of HBeAg-positive CHB before and after treatment were (27 104.07 ± 32 642.11) IU / mL and (12 263.37 ± 19 037.3) IU / mL respectively, with a decrease of 51 ± 39%; HBeAg quantification was (1600.86 ± 2796.52) CI, ± 1 245.39) CI, a decrease of (60 ± 95)%. The HBsAg quantitation before and after HBeAg-negative CHB treatment was (4926.3 ± 6607.88) IU / mL, (2565.77 ± 4110.57) IU / mL, a decrease of (54 ± 42)%. HBeAg-negative CHB group HBsAg, HBeAg quantitative rebound rate 66.03% (35/53), rebound 1,2,3,4,5,6 times more than 11,14,7,2,0,1 cases, a total of 75 cases of rebound Times. HBeAg-positive CHB group HBsAg, HBeAg quantitative rebound rate was 85.18% (69/81), rebound 1,2,3,4,5,6 times were 26,16,12,8,5,2 cases, a total of 163 rebounds , The total rebound 238 cases times. There are 4 modes of rebound. The simultaneous rising of HBsAg and HBeAg is often associated with the poor control of HBV DNA. The decrease of HBsAg and the transformation of HBeAg into the former can be seen. The rising of HBeAg, the rising of HBsAg and the rising of HBeAg are more common. Conclusions The combination of interferon and nucleoside analogues in the treatment of CHB is an ideal solution at present. Prolonged treatment has no breakthrough on HBeAg negative, especially HBsAg negative. Quantitative and frequent rebound of HBsAg and HBeAg in the course of treatment, with plateau and CHB refractory Directly related to timely find and clear the reasons for the rebound, and actively take effective measures to continuously optimize the treatment is expected to reduce the rebound and break the platform effect, improve CHB treatment.