蒋桂华 姜春梅 张俭

[摘要]目的探讨 e-抗原（HBeAg）阳性慢性乙型肝炎采用恩替卡韦联合聚乙二醇干扰素α-2a 治疗的疗效。方法回顾性分析2018年12月至2020年1月于深圳市龙华区人民医院感染科门诊和住院的 e-抗原阳性慢性乙型肝炎患者80例，根據用药将其分成单药组（ n=40）与联合组（ n=40），前者采用恩替卡韦分散片治疗，后者联合聚乙二醇干扰素α-2a 治疗，比较两组患者治疗效果、血清学及病毒学应答率，比较两组患者治疗前后的肝功能指标变化情况，记录两组患者出现的不良反应。结果两组治疗总有效率比较，差异无统计学意义（ P >0.05）;两组 HBV DNA 转阴率比较，差异无统计学意义（ P >0.05），联合组HBeAg转阴率及HBeAg转换率高于单药组，差异有统计学意义（ P <0.05）;治疗前，两组患者的肝功能指标比较，差异无统计学意义（P >0.05）;治疗后，两组 ALT、AST 及 TBIL 等指标均低于治疗前，差异有统计学意义（ P <0.05），但组间比较差异无统计学意义（ P >0.05）;患者用药12周，联合组不良反应发生率均高于单药组，差异有统计学意义（P <0.05）;用药48周，两组不良反应发生率比较，差异无统计学意义（ P >0.05）。结论 e-抗原阳性慢性乙型肝炎采用恩替卡韦联合聚乙二醇干扰素α-2a 治疗较单一恩替卡韦治疗效果相同，均可改善患者肝功能，然而联合治疗患者HBeAg转阴率及HBeAg转换率更高，但其不良反应发生率更高。

[关键词] HBeAg阳性;慢性乙型肝炎;恩替卡韦;聚乙二醇干扰素α-2a

[中图分类号] R512.6+2  [文献标识码] A   [文章编号]2095-0616（2021）24-0093-04

Evaluation of the efficacy of entecavir combined with polyethylene glycol interferonα-2a in the treatment of chronic hepatitis B with positive e-antigen

JIANG  Guihua    JIANG  Chunmei    ZHANG  Jian

Shenzhen Longhua People's Hospital， Guangdong， Shenzhen 518110， China

[Abstract] Objective To explore the therapeutic effect of entecavir combined with polyethylene glycol interferon α-2a in the treatment of chronic hepatitis B with positive e-antigen （HBeAg）. Methods A retrospective analysis was conducted to collect 80 patients with HBeAg-positive from the Outpatient and Inpatient Department of Infectious Diseases Department of Shenzhen Longhua People's Hospital from December 2018 to January 2020. They were divided into the single drug group （n=40） and the combined group （n=40）. The single drug group was treated with entecavir dispersible tablets， while the combined group was treated with polyethylene glycol interferon α-2a on the basis of the single drug group. The therapeutic effect， serological and virological response rates of the two groups were compared， and the changes of liver function indexes before and after treatment were compared， and the adverse reactions of the two groups were recorded. Results There was no significant difference in the total effective rate between the two groups （P >0.05）. There was no significant difference in HBV DNA negative conversion rate between the two groups （P >0.05）， but the HBeAg negative conversion rate and HBeAg conversion rate in the combined group were higher than those in the single drug group， with statistically significant differences （P <0.05）. Before treatment， there was no significant difference in liver function between the two groups （P >0.05）. After treatment， the indexes of ALT， AST and TBIL in the two groups were lower than those before treatment， with statistically significant differences （P <0.05）， but there was no significant difference between the two groups （P >0.05）. After 12 weeks of treatment， the incidence of adverse reactions in the combined group was higher than that in the single drug group， with statistically significant difference （P <0.05）. After 48 weeks， there was no significant difference in the incidence of adverse reactions between the two groups （P >0.05）. Conclusion Entecavir combined with polyethylene glycol interferon α-2ain the treatment of HBeAg-positive has the same effect as entecavir alone， and both can improve the liver function of patients. However， the HBeAg negative conversion rate and HBeAg conversion rate are higher in patients with combined treatment， but with higher incidence of adverse reactions.

[Key words] HBeAg-positive; Chronic hepatitis B; Entecavir; polyethylene glycol interferon α-2a

慢性乙型肝炎是目前世界上极为常见的传染病之一，其主要由乙肝病毒传播引起，使得肝脏发生病变，对其健康危害大。据有效数据调查显示，全世界肝癌患者约一半在中国，而80%以上与乙肝病毒感染相关[1]。抗病毒治疗是疾病治疗的关键……