基於聚乙二醇化干擾素 Alfa-2a 的聯合和間歇療法治療慢性乙

StephenW

基於聚乙二醇化干擾素 Alfa-2a 的聯合和間歇療法治療慢性乙型肝炎與核苷（核苷酸）類似物的經驗導致乙型肝炎表面抗原清除：病例報告
林彥傑 1 , 孫芳芳 2 , 曾展 1 , 畢曉月 2 , 劉洋 2 , 李明輝 1 2 , 謝瑤 1 2
隸屬關係
隸屬關係

    1
    北京大學地壇教學醫院肝病二科，北京，中國。
    2
    首都醫科大學附屬北京地壇醫院肝病科二部。

    PMID：34714178 DOI：10.1089/vim.2021.0112

抽象的

干擾素（IFN）和核苷（核苷酸）類似物（NAs）是兩種有效的慢性乙型肝炎（CHB）抗病毒藥物。越來越多的證據表明，兩種藥物聯合應用可以更好地抑制病毒複製，甚至達到臨床治愈。干擾素間歇治療也被認為是在基於乾擾素的抗病毒治療期間乙肝表面抗原（HBsAg）下降出現停滯時解決干擾素疲勞的重要措施。一名 36 歲男性乙型肝炎 e 抗原 (HBeAg) 陽性 CHB 接受過 NA 病史患者入院。在對富馬酸替諾福韋二吡呋酯（TDF）單藥治療 1 年反應不佳後，患者接受聚乙二醇化干擾素 alfa-2a 聯合治療，最終達到 HBsAg 清除。在治療和隨訪期間，每3個月監測一次HBsAg、HBeAg、乙型肝炎病毒（HBV）DNA、血清丙氨酸轉氨酶等。在聯合治療的第 58 周和第 71 週之間，由於 HBsAg 下降緩慢而停用 IFN，而單獨使用 TDF 進行維持治療。分別在第 44、96 和 122 週觀察到完全病毒學應答、HBeAg 和 HBsAg 血清學轉換。鞏固治療24週後，HBsAg、HBeAg、HBV DNA均呈陰性，聯合治療第146週乙肝表面抗體為729.30 mIU/mL，停藥。在停止治療 28 週後隨訪，患者仍保持臨床治愈。

關鍵詞：NA； PEG干擾素；慢性乙型肝炎;臨床治愈；聯合治療；間歇療法。

StephenW

Combination and Intermittent Therapy Based on Pegylated Interferon Alfa-2a for Chronic Hepatitis B with Nucleoside (Nucleotide) Analog-Experienced Resulting in Hepatitis B Surface Antigen Clearance: A Case Report
Yan-Jie Lin  1 , Fang-Fang Sun  2 , Zhan Zeng  1 , Xiao-Yue Bi  2 , Liu Yang  2 , Ming-Hui Li  1   2 , Yao Xie  1   2
Affiliations
Affiliations

    1
    Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China.
    2
    Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China.

    PMID: 34714178 DOI: 10.1089/vim.2021.0112

Abstract

Interferon (IFN) and nucleoside (nucleotide) analogs (NAs) are two effective antiviral drugs for chronic hepatitis B (CHB). More and more evidence shows that the combination of the two drugs can better inhibit viral replication and even achieve clinical cure. IFN intermittent therapy is also considered to be an important measure to resolve IFN fatigue when hepatitis B surface antigen (HBsAg) decline appears stagnated during IFN-based antiviral therapy. A 36-year-old male NA-experienced patient with hepatitis B e antigen (HBeAg)-positive CHB was admitted to our hospital. After a poor response to tenofovir disoproxil fumarate (TDF) monotherapy for 1 year, the patient was treated with pegylated interferon alfa-2a combination therapy and finally achieved HBsAg clearance. During the treatment and follow-up, HBsAg, HBeAg, hepatitis B virus (HBV) DNA, and serum alanine aminotransferase, etc. were monitored every 3 months. Between weeks 58 and 71 of combination therapy, IFN was discontinued because of a slow decline in HBsAg, and TDF alone was used for maintenance therapy. Complete virological response, HBeAg and HBsAg seroconversion were observed at weeks 44, 96, and 122, respectively. After 24 weeks of consolidation therapy, HBsAg, HBeAg, and HBV DNA were consistently negative, and hepatitis B surface antibody was 729.30 mIU/mL at week 146 of the combination therapy, then we stopped drugs. Following up after 28 weeks of cessation therapy, the patient still remained clinically cured.

Keywords: NAs; Peg interferon; chronic hepatitis B; clinical cure; combination therapy; intermittent therapy.

newchinabok

间歇治疗是指开始治疗有效，后期hbsag下降不了的病人。如果开始应答不好，后面延长治疗和间歇治疗都没用