目的 观察聚乙二醇干扰素α-2a联合阿德福韦酯治疗HBeAg阴性慢性乙型肝炎的临床疗效.方法 沭阳县中心医院2011年1月—2013年1月收治的HBeAg阴性慢性乙型肝炎130例,随机分为干扰素组(43例),阿德福韦酯组(39例)和联合治疗组(48例).干扰素组皮下注射聚乙二醇干扰素α-2a注射液180 μg,每周1次.阿德福韦酯组口服阿德福韦酯片10 mg/次,1次/d.联合治疗组同时给予聚乙二醇干扰素α-2a注射液和阿德福韦酯片,用法用量同以上两组.3组患者均连续治疗48周.观察3组患者丙氨酸氨基转移酶(ALT)复常情况、HBsAg清除情况、HBV DNA转阴情况.结果 治疗24、48、72周,干扰素组、阿德福韦酯组的HBsAg清除率、HBV DNA转阴率均显著低于联合治疗组,差异有统计学意义(P<0.05).3组治疗后ALT、HBV DNA拷贝数、HBsAg水平均较治疗前显著降低,同组治疗前后差异有统计学意义(P<0.05);且干扰素组、阿德福韦酯组患者ALT在治疗48、72周时均高于联合治疗组,差异有统计学意义(P<0.05);两组HBV DNA拷贝数从治疗24周起就高于联合治疗组,差异有统计学意义(P<0.05);干扰素组HBsAg水平在治疗24周、48、72周时均高于联合治疗组,而阿德福韦酯组HBsAg水平仅在治疗48周时高于联合治疗组,差异有统计学意义(P<0.05).结论 聚乙二醇干扰素α-2a联合阿德福韦酯治疗HBeAg阴性慢性乙型肝炎具有较好的临床疗效,两药有一定的协同作用,优于两药单独应用.

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.