| Objective:By observing the dynamic changes of serum markers in patients with chronic hepatitis B during antiviral treatment,the purpose is to explore its relationship with the occurrence and development of chronic hepatitis B,and to provide theoretical basis for judging clinical outcome and prognosis.Methods:A total of 74 patients with chronic hepatitis B from the Department of Hepatobiliary and Pancreatic Medicine of the Second Hospital of Jilin University June 2014 to June 2018 were collected as research objects.All were given conventional liver protection and enzyme reduction treatment,which was divided intointerferon group and entecavir group.38 patients in the interferon group were given PegIFN-α-2a(trade name: Pegasys,Shanghai Roche Pharmaceutical Co.,Ltd.),180 ug subcutaneously,once a week for 48 weeks and followed for 24 weeks;36 patients in the entecavir group were given entecavir(trade name: Runzhong,Zhengda Tianqing Pharmaceutical Group Co.,Ltd.),0.5mg,orally before or 2 hours after a meal,once a day for72 weeks.The levels of HBV DNA,HBsAg,HBeAg,liver function ALT,AST,GGT,TBIL and other biochemical indicators,Liver transient elastography(liver stiffness value,kPa)were observed at before treatment,4 weeks,12 weeks,24 weeks,48 weeks,72 weeks or 24 weeks of follow-up.In the interferon group at24 weeks of follow-up,the patients that reached HBV DNA negativetransformation(HBV DNA<100IU/ml)were defined as sustained virological response(SVR),and those who did not meet the SVR criteria were non-responders.Results:1.Changes of HBV DNA and HBsAg in different groups before and after treatment In the interferon group at 12 weeks,24 weeks,48 weeks and 24 weeks of follow-up,the decrease of HBVDNA and HBsAg levels were significantly different from that before treatment(P<0.05,P<0.05).In the entecavir group at 4 weeks,12 weeks,24 weeks,48 weeks and 72 weeks,the decline of HBV DNA levels was significantly different from that before treatment(P<0.05),while the decline of HBsAg levels was not significantly different from that before treatment(P>0.05).At different time points of 4weeks,12 weeks,24 weeks,48 weeks,72 weeks or 24 weeks of follow-up,the decrease of HBVDNA levels in the entecavir group was significantly greater than that in the interferon group,and the difference was statistically significant(P<0.05).At 12 weeks,24 weeks,48 weeks,72 weeks or 24 weeks of follow-up,the decline of HBsAg levels in the interferon group was significantly greater than that in the entecavir group.The difference was statistically significant(P<0.05).2.Improvement of liver function in different groups before and after treatment The improvement of liver function indexes ALT,AST,TBIL and GGT in the interferon group at 12 weeks,24 weeks and 48 weekswas significantly different from that before treatment(P<0.05).The improvement of liver function indexes ALT,AST,TBIL and GGT in the entecavir group at 4weeks,12 weeks,24 weeks and 48 weeks was significantly different from that before treatment(P<0.05).The improvement of liver function indexes ALT,AST,TBIL and GGT in the entecavir group at 4 weeks was significantly better than that in the interferon group.The difference was statistically significant(P<0.05).At 12 weeks,24 weeksand 48 weeks,the difference between the interferongroup andthe entecavir group was not statistically significant(P>0.05).3.Changes of liver stiffness value in different groups before and after treatment The liver stiffness value in the entecavir group at 12 weeks,24 weeks and 48 weeks was significantly lower than that before treatment.The difference was statistically significant(P<0.05).The liver stiffness value in the interferon group at 24 weeks and 48 weeks was significantly lower than that before treatment,the difference was statistically significant(P<0.05).The difference at 12 weeks between the interferon group and the entecavir group was statistically significant(P<0.05).The entecavir group was superior to the interferon group in improving liver fibrosis and reducing the progression of liver stiffness value.4.The virological and serological response in different groups after treatment The HBV DNA negative transformation rate was measured at 4weeks,12 weeks,24 weeks,48 weeks,72 weeks or 24 weeks of follow-up with the result showing that the interferon group were 0.00%,10.53%,23.68%,39.47% and 34.21%,and the entecavir group were 22.22%,41.67%,61.11%,77.78% and 77.78%.At 4 weeks,12 weeks,24 weeks,48 weeks,72 weeks or24 weeks of follow-up,the entecavir group was significantly better than the interferon group.The difference was statistically significant(P<0.05).The HBeAg clearance rate was measured at 4 weeks,12 weeks,24 weeks,48 weeks,72weeks or 24 weeks of follow-up with the result showing that the interferon group were 0.00%,0.00%,13.16%,23.68% and 23.68%,and the entecavir group were 0.00%,0.00%,2.78%,8.33% and 11.11%.There was no significant difference between the interferon group and the entecavir group(P>0.05).The HBeAg seroconversion rate was measured at 4 weeks,12 weeks,24 weeks,48 weeks,72 weeks or 24 weeks of follow-up with the result showing that the interferon group were 0.00%,0.00%,10.53%,28.95% and28.95%,and the entecavir group were 0.00%,0.00%,2.78%,5.56% and8.33%.At 48 weeks,72 weeks or 24 weeks of follow-up,the interferon group was significantly better than the entecavir group,the difference wasstatistically significant(P<0.05).The HBsAg clearance rate was measured at 4weeks,12 weeks,24 weeks,48 weeks,72 weeks or 24 weeks of follow-up with the result showing that the interferon group were 0.00%,0.00%,2.63%,15.79% and 15.79%.There was no HBsAg clearance in the entecavir group.At48 weeks,72 weeks or 24 weeks of follow-up,the interferon group was significantly better than the entecavir group,and the difference was statistically significant(P<0.05).The HBsAg seroconversion rate was measured at 4weeks,12 weeks,24 weeks,48 weeks,72 weeks or 24 weeks of follow-up with the result showing that the interferon group were 0.00%,0.00%,0.00%,2.63%and 2.63%.There was no HBsAg seroconversion in the entecavir group.There was no significant difference between the interferon group and the entecavir group(P>0.05).5.Prediction of SVR by baseline level of ALT and the decrease of HBsAg treatment process According to the baseline level of ALT before treatment,the interferon group was divided into 20 patients with 5-10 ULN and 18 patients with 2-5ULN.In the 5-10 ULN group at 24 weeks of follow-up,the SVR rate was 50.00%,and the HBeAg seroconversion rate was 45.00%.In the 2-5ULN group at 24 weeks of follow-up,the SVR rate was 16.67%,and the HBeAg seroconversion rate was 11.11%.There was a significant difference between the 5-10 ULN group and the 2-5ULN group(P<0.05).According to the level of HBsAg decline at 24 weeks of treatment,the patient was divided into three groups: HBsAg<1500IU/ml,1500IU/ml ≦ HBsAg ≦ 20000IU/ml and HBsAg>20000IU/ml.In respectively three groups at 24 weeks of follow-up,the SVR rate were 69.23%,21.43% and 9.09%,and the HBeAg seroconversion rate were 61.54%,14.29% and 9.09%.In the HBsAg<1500IU/ml group at 24 weeks of follow-up,the SVR rate and the HBeAg seroconversion rate were significantly better than those of 1500IU/ml≦HBsAg≦20000IU/ml group and HBsAg>20000IU/ml group,the difference was statistically significant(P<0.05,P<0.05).At 24 weeks follow-up,there was no significant difference betweenthe 1500IU/ml ≦ HBsAg ≦ 20000IU/ml group and the HBsAg>20000IU/ml group(P>0.05).Conclusion:1.Entecavir is superior to PegIFN-α-2a in rapidly reducing liver function indexes and HBV DNA in patients with chronic hepatitis B;2.Entecavir is better than PegIFN-α-2a in improving the degree of liver fibrosis and reducing the progression of liver stiffness value;3.PegIFN-α-2a is superior to entecavir in HBeAg seroconversion and HBsAg clearance in patients with chronic hepatitis B;4.The baseline level of ALT and the decrease of HBsAg treatment process can be used as predictors of viral immune response. |
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