本文選題：肝炎 + 干擾素�。� 參考：《安徽醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的觀察慢性乙型肝炎（CHB）患者接受普通干擾素（IFN）治療后不同時(shí)期的外周血ALT、HBV DNA、HBsAg、HBeAg滴度的變化，并探討其與治療結(jié)束后HBeAg血清學(xué)應(yīng)答之間的關(guān)系。 方法對(duì)115例使用普通干擾素治療的HBeAg陽(yáng)性CHB患者在其知情同意的情況下隨訪(fǎng)48周，分別于抗病毒治療的基線(xiàn)（0周）、12周、24周、48周時(shí)收集患者的血清，定量檢測(cè)HBsAg、HBeAg、HBV DNA、ALT水平。并分析治療基線(xiàn)時(shí)相關(guān)指標(biāo)的水平及治療后不同時(shí)期（12周、24周）時(shí)外周血的ALT、HBV DNA、HBsAg、HBeAg滴度變化與IFN治療HBeAg陽(yáng)性CHB患者發(fā)生HBeAg血清學(xué)應(yīng)答之間的關(guān)系。 結(jié)果抗病毒治療48周后，初始時(shí)115例患者接受普通干擾素治療，，其中失訪(fǎng)14例，治療中換或（聯(lián)合）核苷類(lèi)似物治療18例，臨床資料不完善4例，未能完成48周的基本療程7例。共剩余72例完成48周的IFN治療，其中28例患者發(fā)生HBeAg血清學(xué)轉(zhuǎn)換，44例患者HBeAg仍為陽(yáng)性。在獲得HBeAg血清學(xué)轉(zhuǎn)換與未獲得血清學(xué)轉(zhuǎn)換的患者中治療基線(xiàn)（0周）時(shí)ALT水平及HBeAg滴度的差異有統(tǒng)計(jì)學(xué)意義。IFN治療12周、24周的HBV DNA、HBeAg、HBsAg滴度水平分別小于6.511g copies/ml、3.831g copies/ml，2.38lg S/CO、0.87lg S/CO，4.33IU/ml、4.07IU/ml時(shí)治療結(jié)束后HBeAg血清學(xué)轉(zhuǎn)換率高。12周時(shí)HBV DNA下降較基線(xiàn)時(shí)超過(guò)27%，12周、24周時(shí)HBeAg水平下降率超過(guò)71%、95%及HBsAg較基線(xiàn)下降超過(guò)65%、47%時(shí)能較好的預(yù)測(cè)治療結(jié)束時(shí)HBeAg血清學(xué)轉(zhuǎn)換率。 結(jié)論HBeAg陽(yáng)性CHB患者在接受普通IFN治療時(shí)可根據(jù)基線(xiàn)時(shí)ALT、HBeAg水平預(yù)測(cè)其治療48周后的HBeAg血清學(xué)轉(zhuǎn)換率，同時(shí)治療后動(dòng)態(tài)觀察HBV DNA、HBeAg、HBsAg的定量水平變化有利于指導(dǎo)治療，若治療后HBV DNA、HBeAg、HBsAg水平較基線(xiàn)快速下降能很好的預(yù)測(cè)療程結(jié)束后的HBeAg血清學(xué)應(yīng)答，且HBeAg水平變化較HBV DNA及HBsAg水平變化在預(yù)測(cè)普通IFN治療HBeAg陽(yáng)性CHB患者中能否獲得血清學(xué)應(yīng)答的敏感性和特異性更佳。
[Abstract]:Objective To observe the changes of ALT, HBV DNA, HBsAg and HBeAg titers in peripheral blood of patients with chronic hepatitis B (CHB) after receiving regular interferon (IFN) treatment, and to explore their relationship with HBeAg serological response after treatment.
Methods to treat 115 cases of interferon HBeAg positive CHB patients after informed consent were followed for 48 weeks, respectively in antiviral therapy at baseline (0 weeks), 12 weeks, 24 weeks, the serum were collected at 48 weeks, quantitative detection of HBsAg, HBeAg, HBV, DNA, ALT and the analysis of different levels. During the period of treatment at baseline level and related indicators (after 12 weeks, 24 weeks) of peripheral blood ALT, HBV, DNA, HBsAg, the relationship between the occurrence of HBeAg serological response HBeAg titer changes and IFN treatment of HBeAg positive CHB patients.
Results 48 weeks after antiviral therapy, 115 patients received interferon treatment initially, of which 14 cases were lost, or for the treatment of nucleoside analogues (joint) treatment in 18 cases, the clinical data of 4 cases of incomplete, failed to complete the basic course of 48 weeks. A total of 7 cases of residual IFN treatment completed 48 weeks of 72 cases among them, 28 patients underwent HBeAg seroconversion, 44 cases of patients with HBeAg remained positive. The baseline in patients received HBeAg seroconversion and without seroconversion (0 weeks) in different levels of ALT and HBeAg was statistically significant.IFN for 12 weeks, HBV DNA, HBeAg for 24 weeks, the level of HBsAg titer 6.511g 3.831g copies/ml are less than copies/ml, 2.38lg, S/CO, 0.87lg, S/CO, 4.33IU/ml, 4.07IU/ml after the end of treatment HBeAg seroconversion rate in high.12 weeks and HBV DNA were lower than 27% at baseline, 12 weeks, 24 weeks at the HBeAg level drop rate of more than 71%, 95% and HBsAg The decrease of the baseline was more than 65%, and the HBeAg serological conversion rate was well predicted at the end of the treatment at the end of the treatment.
Conclusion HBeAg positive CHB patients according to the baseline ALT in an ordinary IFN treatment, the forecast after 48 weeks of treatment, HBeAg seroconversion rate of HBeAg level, the dynamic observation of HBV DNA, and HBeAg after treatment, the changes of quantitative level of HBsAg is helpful to guide treatment, if HBV after treatment of DNA, HBeAg, HBsAg compared to the baseline level fast HBeAg can decrease the serologic response very well after the end of the forecast period, and the changes of HBeAg levels than HBV DNA and HBsAg IFN levels in the prediction of common treatment of HBeAg positive CHB patients can obtain serological response sensitivity and specificity was better.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R512.62

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 譚淑燕;鄒敏超;上官輝;;HBsAg定量對(duì)聚乙二醇干擾素治療HBeAg陰性慢性乙型肝炎療效預(yù)測(cè)價(jià)值[J];海南醫(yī)學(xué);2013年19期

2 姚光弼,崔振宇,姚集魯,張定鳳,籍納新,黃瑛;國(guó)產(chǎn)拉米夫定治療2 200例慢性乙型肝炎的Ⅳ期臨床試驗(yàn)[J];中華肝臟病雜志;2003年02期

3 王貴強(qiáng);應(yīng)重視HBeAg陰性慢性乙型肝炎的診斷和治療[J];中華內(nèi)科雜志;2005年09期

4 楊創(chuàng)國(guó),于樂(lè)成,陳金軍,孫劍,郭亞兵,駱抗先,朱幼芙,侯金林;1686例慢性乙型肝炎中HBeAg陰性與陽(yáng)性患者臨床和病毒學(xué)特點(diǎn)比較分析[J];中華內(nèi)科雜志;2005年09期

5 郭芳;馬慧;魏來(lái);孫焱;王豪;;HBeAg陰性慢性乙型肝炎9年前瞻性研究[J];中華實(shí)驗(yàn)和臨床病毒學(xué)雜志;2006年04期

本文編號(hào)：1735506