| Objective: By observing the efficacy of pegylated interferon in the treatment of HBeAg positive chronic hepatitis B(CHB),and analyzing the relationship between the level of related factors and the curative effect before treatment,12 weeks,24 weeks and 48 weeks after treatment(at the end of treatment),to guide and optimize the treatment plan.Methods: In a retrospective study,patients who were hospitalized and discharged from our hospital from January 2018 to January 2020 were selected for follow-up.All patients with HBeAg-positive chronic hepatitis B were given pegylated interferon 180 ug subcutaneously once a week for 48 weeks,all of them were treated with pegylated interferon 180 ug subcutaneously once a week for 48 weeks.According to whether the HBV DNA load was lower than the lower limit of the detection value((HBV DNA <30IU/m L)after 48 weeks of treatment,the patients were divided into two groups: negative group and non-negative group,and the antiviral effect was observed.The levels and changes of HBsAg,HBeAg,HBV DNA,ALT and AST were compared between the two groups before treatment,12 weeks,24 weeks and 48 weeks after treatment.At the same time,the changes of blood routine and adverse reactions were observed,and the relationship between the above factors and antiviral efficacy was analyzed.Results:1.In 100 patients with HBeAg positive chronic hepatitis B,the,HBV DNA negative conversion rates of pegylated interferon treatment for 12 weeks,24 weeks and 48 weeks were 12%(12 / 100),36%(36 /100)and 46%(46 / 100),respectively.That is,after 48 weeks of treatment,the negative conversion rate of HBV DNA can reach 46%.2.After 48 weeks of pegylated interferon treatment,there were 46 cases in negative group and 54 cases in non-negative group.There was no significant difference in sex and age between the two groups(p > 0.05).There was no significant difference in baseline HBs Ag,HBV DNA,ALT,AST and blood routine between the two groups,but there was a significant difference in the median of baseline HBe Ag between the two groups,with a median of11.95PEIU/mL HBeAg in the negative group and 95.95PEIU/mL HBe Ag in the non-negative group.The difference between the two groups was statistically significant,suggesting that baseline HBeAg less than 11.95PEIU/mL is a predictor of negative HBV DNA.3.At 12 weeks of treatment,the median HBV DNA of negative conversion group andnon-negative conversion group decreased to 2.05(log10IU/ML)and 3.73(log10IU/ML),respectively,and there was significant difference between the two groups(P <0.001).At24 weeks of treatment,69.57%(32 / 46)patients in negative conversion group had HBV DNA negative conversion,and the median HBV DNA in non-negative conversion group was3.22(log10IU/ML),and there was significant difference between the two groups(P<0.001).After 48 weeks of treatment,the median HBV DNA of the non-negative group was 3.03(log10IU/ML).It is suggested that HBVDNA 2.05(log10IU/ML)at 12 weeks after treatment,HBVDNA turned negative at 24 weeks,and HBVDNA negative rate at 48 weeks is higher,which can predict the antiviral efficacy at 48 weeks.4.After 12 weeks of treatment,the decrease of HBV DNA in negative group was 2.74 mg /ml,and that in non-negative group was 1.67 lgIU / ml.There was significant difference between the two groups(P <0.05).At 24 weeks of treatment,the decrease of HBV DNA in the negative group was 5.23 lgIU/ml,and 2.44 lgIU/ml,in the non-negative group(P <0.05).It is suggested that after 12 weeks of treatment,the decrease of HBVDNA is more than 2.741 g IU / ml HBVDNA.After 24 weeks of treatment,the decrease of HBVDNA is more than 5.231 gIU / ml.48 weeks after treatment,the negative rate of HBVDNA is higher,and a better virological response can be obtained.5.After 12 weeks of treatment,the median HBeAg of negative conversion group was 0.54PEIU/ml,and that of non-negative conversion group was 5.64 PEIU/ml,.After 24 weeks of treatment,the median HBeAg in the negative conversion group was 0.77 PEIU/ml,and 3.83PEIU/ml,in the non-negative group(P<0.05).It is suggested that the patients with HBeAg<0.54 PEIU/ml after 12 weeks of treatment have higher HBV DNA negative after 48 weeks of treatment.After 12 weeks of treatment,the decrease of HBeAg in the negative conversion group was 0.55 lg PEIU / ml,and that in the non-negative conversion group was0.56 lg PEIU / ml,.There was no significant difference between the two groups(P>0.05).After 24 weeks of treatment,the decrease of HBe Ag in 0.84 lg PEIU / ml,negative group was1.14 lg PEIU / ml,and there was no significant difference between the two groups(P >0.05).It is suggested that there is no significant change in the decrease of HBe Ag in the two groups at 12 and 24 weeks of treatment,indicating that the decrease of HBe Ag in the early stage of treatment may not be of great significance in predicting the curative effect of 48 weeks.6.At 12 weeks,24 weeks and 48 weeks after treatment,the quantity of HBsAg in the negative conversion group was(3.05 ±0.88)lgIU/ml,(2.81 ±0.96)lgIU/ml and(2.67 ±1.00)lgIU/ml,respectively,and that in the non-negative group was(3.18 ±0.69)lgIU/ml,(3.07 ±0.60)lgIU/ml and(2.98 ±0.59)lgIU/ml,respectively.During the treatment of the two groups,the quantity of HBsAg decreased gradually at each time point at 12 weeks,24 weeks and 48 weeks,but there was no significant difference between the two groups(p >0.05).Further analysis of the extent of quantitative decrease of HBsAg at 12 weeks,24 weeks and 48 weeks after treatment showed that the quantitative decrease of HBsAg in the negative group at 12 weeks,24 weeks and 48 weeks decreased by 0.31 lgIU/ml,0.71lgIU/ml and 0.89 lgIU/ml,respectively,by 0.33 lgIU/ml,0.36 lgIU/ml and 0.46 lgIU/ml,respectively,but there was no significant difference between the two groups.7.After 12 weeks of treatment,the normalization rates of ALT and AST in the negative conversion group were 8.7% and 28.26%,respectively,while those in the non-negative group were 11.11%,31.48% and 31.48%,respectively.After 24 weeks of treatment,the normalization rates of ALT and AST in the negative conversion group were 34.78% and46.65%,respectively,while those in the non-negative group were 37.04% and 48.15%,respectively.There was no significant difference between the two groups(P>0.05).After48 weeks of treatment,the normalization rates of ALT and AST in the negative conversion group were 56.52% and 78.26%,respectively,and the normalization rates of ALT and AST in the non-negative group were 27.78% and 51.85%,respectively.The normalization rate of ALT in the negative conversion group was significantly higher than that in the non-negative group(P< 0.01).8.In the course of treatment,the main adverse reactions of the two groups were influenza-like symptoms and myelosuppression.there was no significant difference in blood routine indexes and adverse reactions between the two groups(p > 0.05).Conclusion:1.Pegylated interferon in the treatment of HBeAg positive chronic hepatitis B has good efficacy,mild adverse reactions,tolerable and high safety.2.Before treatment,the HBe Ag was less than 11.95 PEIUGML,and the negative conversion rate of HBVDNA was higher after 48 weeks of treatment.3.The HBVDNA of 12 weeks after treatment was less than 2.05(log10IU/ML),and the HBVDNA turned negative at 24 weeks,and the negative rate of HBVDNA at 48 weeks was higher,which could predict the antiviral efficacy at 48 weeks.4.After 12 weeks of treatment,the decrease of HBVDNA was more than 2.74 lg IU / ml.After24 weeks of treatment,the decrease of HBVDNA>5.23 lg IU / ml.was higher than that ofHBVDNA after 48 weeks of treatment,and a better virological response could be obtained.6.After 48 weeks of treatment,HBVDNA turned negative,and a higher rate of ALT normalization was obtained. |
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