Low Surface Antigen Patients With Chronic Hepatitis B Treated With Nucleoside Analogues(NAs) Combined With Pegylated Interferon α-2b Functional Therapy

Aims In order to search for nucleoside(acid)analogues(NAs)with low surface antigen level(HBsAg<1500IU/mL)patients with Chronic Hepatitis B(CHB)were treated with peginterferonα-2b(Peg-IFNα-2b).To find the disappearance rate of HBsAg after treatment,and the level of HBsAg was analyzed by stratification.To search the highest disappearance rate of HBsAg was initially determined which baseline level of HBsAg was,and the prediction factors of HBsAg disappearance were analyzed.Methods Patients with CHB(HBsAg<1500IU/mL)were treated with NAs combined with subcutaneous injection of pegylated interferonα-2b(180μg,a time/week)for 24 weeks.Liver function,blood routine,HBV-DNA,HBsAg,anti HBS and HBe Ag were detected before and after treatment.Thyroid function,thyroid related antibodies and other autoantibodies,abdominal ultrasound and Fibro Scan were monitored at baseline and every 12 weeks.HBsAg≤0.05 IU/mL was regarded as negative,HBe Ag≤0.018 IU/mL was regarded as curative effect.Non parametric test was used to analyze the related factors of HBsAg disappearance.Bonferroni analysis was used to explore the best curative effect which the baseline HBsAg was.ROC analysis was used to explore the predictive factors of HBsAg disappearance and which group had the best curative effect under different levels of baseline HBsAg.Results A total of 84 patients were included in the study.After 24 weeks of treatment,38 cases(38/84,58.2%)achieved HBsAg clearance,25 cases(25/37,67.6%)turned negative at 0-100 IU/mL,9 cases(9/25,36.0%)turned negative at100-500 IU/mL,and 4 cases(4/22,18.2%)turned negative at 500-1500 IU/mL.At 24weeks,5 cases(5/22.22.7%)turned negative when e antigen was positive(>0.18),and 33 cases(33/62,53.2%)turned negative when e antigen was negative.The baseline age and median level of HBsAg in HBsAg disappearance group were lower than those in HBsAg non disappearance group(z=-2.366,-4.296;P=0.018,0.000).In the HBsAg disappearance group,the proportion of patients with HBe Ag negative history of spontaneous negative conversion was higher than that in the HBsAg non disappearance group,the difference was statistically significant(?~2=6.097,P=0.014).When the baseline level was 0-100IU/mL,it was easier to achieve HBsAg clearance.Age,Baseline HBsAg level,HBsAg level at 12 weeks of treatment,Transaminase level at 12 weeks and 24 weeks of treatment,And transaminase level at12 weeks and 24 weeks of treatment were all independent factors for predicting the disappearance of HBsAg.The area under the curve of baseline HBsAg level was0.773(95%=0.672-0.875),the sensitivity was 84.8%,and the specificity was 60.5%.After 12 weeks of treatment,the area under the curve of HBsAg level was 0.937(95%CI=0.891-0.984),the sensitivity was 87.0%,and the specificity was 86.8%.Conclusions For patients with low surface antigen treated with NAs,the combination of pegylatedα-2b interferon treatment for 24 weeks can achieve a higher rate of HBsAg disappearance,and it is easier to achieve when the baseline HBsAg is in 0-100 IU/mL.The baseline HBsAg level of 0-100IU/mL,the level of HBsAg at 12 weeks of treatment,the level of transaminase at 12 weeks,24 weeks of treatment and the level of transaminase at 12 weeks of treatment all had predictive value for the disappearance of HBsAg.The baseline HBsAg level and the level of HBsAg at 12 weeks of treatment had higher predictive value.