目的 探讨Peg-IFN-α2a (pegylated interferon α2a)联合肝复乐胶囊对HbeAg阳性慢性乙型肝炎(chronic hepatitis B, CHB)患者肝纤维化指标的影响及抗病毒疗效。方法 108例HbeAg阳性CHB患者来源于2013-03至2016-02我院感染科门诊。按照不同治疗方案分成两组,A组:Peg-IFN-α2a联合肝复乐胶囊治疗组(n=56);B组:Peg-IFN-α2a治疗组(n=52);疗程48周。收集患者治疗全程HBV DNA水平、肝功能、肝纤维化血清标志物及FibroScan等临床指标。比较各组治疗前后及两组间上述指标差异。结果 A组患者经治疗48周后HBV DNA水平(LOG10 copies/ml)由6.78±1.36下降至2.36±0.42;B组患者HBV DNA水平由6.54±1.25下降至2.43±0.37。A组经治疗48周后ALT水平由(106.62±36.74)U/L下降至(33.22±8.75)U/L;B组ALT水平由(113.57±40.29) U/L下降至(40.64±11.37) U/L。两组患者HBV DNA水平及ALT水平均较基线时均明显下降(P<0.01)。两组经治疗48周后血清透明质酸(hyaluronic acid, HA)、层粘连蛋白(laminin, LN)、三型前胶原N端肽(three former type collagen n-terminal peptide, PⅢP)和Ⅳ型胶原(type Ⅳ collagen, CⅣ)水平较基线时均明显下降(P<0.01)。治疗终点时A组患者血清HA、LN 、PⅢP和CⅣ水平均显著低于B组水平(P<0.05)。A组患者经治疗48周后Fibroscan值(12.78±3.32) kPa下降至(7.43±2.21)kPa;B组患者Fibroscan值由(13.34±3.35)kPa下降至(9.24±2.06)kPa。两组患者经治疗后Fibroscan值较基线时均明显下降(P<0.01)。治疗终点时A组患者Fibroscan值显著低于B组(P<0.05)。结论 Peg-IFN-α2a联合肝复乐胶囊可以更好地改善HbeAg阳性CHB患者肝纤维化指标。

Objective To investigate the anti-liver fibrosis effect of pegylated interferon α2a(Peg-IFN-α2a) combined with Ganfule capsules on patients with HbeAg postive chronic hepatitis B(CHB).Methods 108 patients with HbeAg postive CHB were divided into two groups. Patients in group A(n=56) were treated with Peg-IFN-α2a and Ganfule capsules, while patients in group B(n=52) were treated with Peg-IFN-α2a alone. The course of treatment of the two groups was 48 weeks. The liver function, HBV DNA level, serum marker of liver fibrosis and Fibroscan score over the 48 weeks were collected and analyzed. ELISA method was performed to measure the level of serum hyaluronic acid (HA), laminin (LN), procollagen Ⅲ N-terminal peptide (PⅢP), and type Ⅳ collagen (CⅣ).Results At the 48 th week, the level of HBV DNA (LOG10 copies/ml) was decreased from (6.78±1.36 )to (2.36±0.42 ) in group A and from( 6.54±1.25 )to( 2.43±0.37)in group B. The level of ALT was decreased from(106.62±36.74)U/L to (33.22±8.75)U/L group A and that from(113.57±40.29)U/L to(40.64±11.37)U/L group B. The level of HBV DNA and ALT in both groups was significantly decreased compared with the level at baseline (P<0.01). The level of serum HA, LN, PⅢP and CⅣ in both groups was also significantly decreased (P<0.01). Furthermore, the levels of serum HA, LN, PⅢP and CⅣ at the 48 th week were significantly lower in group A (P<0.05). The Fibroscan score of group A were decreased from(12.78±3.32)Kpa to(7.43±2.21)Kpa and that of group B from (13.34±3.35)kPa to(9.24±2.06)kPa. The Fibroscan scores in both groups were significantly decreased compared with the level at baseline (P<0.01).Also, Fibroscan scores at the 48th week were significant lower in group A than in group B(P<0.05).Conclusions The combination of Peg-IFN-α2a with Ganfule capsules can more effectively improve liver fibrosis of patients with HbeAg postive CHB.