α-干扰素治疗慢性乙型肝炎患者的长期随访

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文题：Long-term follow-up of alpha-interferon treatment of patients with chronic hepatitis B. 作者：van Zonneveld M, Honkoop P, Hansen BE, Niesters HG, Murad SD, de Man RA, Schalm SW, Janssen HL. 杂志全名：Hepatology 年份，卷（期）: 起止页码：2004;39(3):804-10. PMID：14999700 英文摘要： Data on the long-term effects of interferon alfa (IFN) treatment on disease progression and mortality in patients with chronic hepatitis B (CH are limited. To evaluate factors that influence clinical outcome and survival, we performed a follow-up study on 165 hepatitis B e antigen (HBeAg) positive CHB patients treated with IFN between 1978 and 2002. The median IFN dose was 30 megaunits (MU)/week (range, 2-70 MU/week), and the median duration of therapy was 16 weeks (range, 1-92 weeks). Response to treatment was defined as HBeAg loss within 12 months after the end of IFN therapy. Median follow-up was 8.8 years (range, 0.3-24 years). Fifty-four patients (33%) responded to IFN treatment. Relapse (HBeAg reactivation) occurred in 7 of the 54 (13%) responders. Fifty-two percent of the responders lost hepatitis B surface antigen (HBsAg) as compared with 9% of the nonresponders (P <.001). Liver histology showed a decreased necroinflammatory activity and less progression of fibrosis in responders. Twenty-six patients died during follow-up. Hepatocellular carcinoma (HCC) was found in 8 patients, 6 of whom were nonresponders. Of the two responders who developed HCC, one patient had relapsed after discontinuation of therapy. Multivariate analysis showed significantly improved survival (relative risk (RR) of death 0.28, 95% CI 0.10-0.78) and reduced risk of developing HCC (RR 0.084, 95% CI 0.09-0.75) in responders. In conclusion, response to IFN therapy results in a prolonged clinical remission with an increased rate of HBsAg seroconversion and improved liver histology. Our results indicate that after correction for baseline factors, response to IFN therapy increases survival and reduces the risk of developing HCC. 中文译文： α-干扰素治疗慢性乙型肝炎患者的长期随访 [摘要] 背景与目的; 有关α-干扰素（ IFN ）治疗的慢性乙型肝炎患者的进展与死亡率的长期结果资料还不多. 方法; 为评价影响临床结果与生存率的因素，我们对1978年--2002年165例α-干扰素治疗的慢性乙型肝炎HBeAg阳性患者进行长期随访研究。中位IFN 剂量是30 MU/周(范围, 2-70 MU/周),中位疗程为16周（范围，1--92周），治疗应答定义为IFN治疗末后12个月内HBeAg阴转 ,中位随访时间为8.8年（范围，0.3--24年）. 结果; 54例患者 (33%)IFN治疗产生应答，7例应答患者（7/54，13%）复发（HBeAg再发阳性）.52%的应答患者HBsAg阴转而无因答者仅有9%(P < 0.001). 肝脏组织学显示应答者炎症坏死活性降低，纤维化进展减少.在随访期间26例患者死亡. 8例患者出现肝癌，其中6例为无因答者，2例出现肝癌的应答者中1例为在中止治疗后复发的患者.多变量分析显示在应答者显著改善生存率(RR 0.28, 95% CI 0.10-0.78)减少肝癌发生风险(RR 0.084, 95% CI 0.09-0.75). 结论； IFN治疗应答可导致临床缓解延长,增长的HBsAg血清转换以及肝脏组织学改善,我们的结果表明在修正基线因素后IFN治疗应答增加了生存率，降低了肝癌发生风险。

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