Clinical Efficacy Of Pegylated Interferon α-2a In The Treatment Of Chronic Hepatitis B Patients With Entecavir And The Role Of IL-29 In The Elimination Of Hepatitis B Virus

Objective:To evaluate the efficacy and safety of pegylated interferon(IFN)in the treatment of chronic hepatitis B(CHB)patients with entecavir(ETV)and provide a more effective and reasonable treatment plan for the clinical cure of chronic hepatitis B.Methods:Fifty patients with CHB treated with ETV were enrolled in our study,whose virological negative conversion had been realized(HBVDNA<500copies/ml)but the clinical cure goal was not reached.The subjects were devided equally into two groups in the principle of voluntariness and seperately treated with ETV(0.5mg/d,qd)combined with Peg-IFNα-2a(180μg/0.5ml,qw)or ETV(o.5mg/d,qd)alone.The course of treatment was 48 w.The negative rate of HBeAg,the serological conversion rate of HBeAg,the level of HBsAg,the negative rate of HBsAg and the adverse reactions of two groups were observed in the 0w,12 w,24w,48 w of the treatment.The third part of this paper included horizontal and longitudinal research.Horizontal research was divided into normal control group,ETV group,IFN-α group,PEG-IFNα-2a+ETV group,and the peripheral blood serum of these groups were collected respectively.In the longitudinal study,the peripheral blood serum samples of PEG-IFNα-2a+ETV group from 0 week,12 weeks,24 weeks,48 weeks in the treatment were collected,and the peripheral blood serum at 24 weeks was selected for transversal control study.To observe the level differences of IL-29 among different groups in the horizontal research and the change of IL-29 in the longitudinal study.Results:1.49 patients were observesd for 48 weeks in the study including 24 patients(Peg-IFNα-2a+ETV group)and 25 patients(ETV group).There was no significant difference between two groups in the negative rate of HBeAg,the serological conversion rate of HBe Ag and the negative rate of HBsAg(P>0.05).2.The HBs Ag level of Peg-IFNα-2a+ETV group in the 12 w,24w,48 w were decreased significantly than ETV group and the difference between two groups was statistically significant(P<0.05).There was significant difference in the incidence of adverse reactions between two groups(P<0.05).3.There were no significant differences among four groups in the level of IL-29(p>0.05).The level of IL-29 in ETV group was lower than that in IFN-α group and ETV+PEG-IFNα-2a group,but the differences were not statistically significant(P > 0.05).Furthermore,IL-29 level in IFN-α group was lower than that in ETV+PEG-IFNα-2a group,but the differences were not statistically significant(P >0.05).4.There was no significant difference about the level of IL-29 when compared HBeAg positive patients with HBeAg negative patients in ETV group,IFN-α group,PEG-IFNα-2a+ETV group respectively(P > 0.05).5.The IL-29 level increased gradually with the prolongation of the treatment in the ETV+PEG-IFNα-2a group,but the differences of IL-29 level between two time point of treatment at 0w,12 w,24w,48 w had no statistical significance(P > 0.05).6.The IL-29 level increased gradually with the prolongation of the treatment in the CR group of ETV+PEG-IFNα-2a group,but the differences between two time point of treatment at 0w,12 w,24w,48 w had no statistical significance(P > 0.05).And there was no significant difference about the level of IL-29 at different time point in the NCR group.There was also no difference about the level of IL-29 when compared CR group with NCR group at different time point.Conclusions:1.Sequential combination of pegylated interferon(PegIFN)in the CHB patients treated with ETV can effectively reduce the level of HBsAg.However,it is necessary to integrate the adverse drug reactions and the economic level of the patients when we select a reasonable antiviral treatment plan.2.Interferon α can induce the expression of IL-29 to enhance antiviral activity by regulating body immunity,and the level of IL-29 can be increased with the prolongation of treatment.However,endogenous IL-29 production may be related to cell sensitivity or individual genotypes.3.The expression of IL-29 in the peripheral blood of patients with chronic hepatitis B in the treatment is not obvious,and its mechanism is complex.Therefore,it is necessary to study the cytokines of IL-29 and fully understand its immune activity and its possible advantages and disadvantages as a therapeutic method.Furthermore,the mechanism of interferon stimulating IL-29 production in vivo still needs to be further explored.