| Objective: HBV DNA replication is an important risk factor for disease progression after HBV infection,antiviral treatment is the key to the treatment of chronic hepatitis B.Currently,the treatment for CHB are including(pegylated)interferon and nucleoside analogues(NA)(acid).For the effect of different factors including host,virus,and immunity,only part of patients who receive the treatment of interferon can accept sustained virological response,and the lifelong treatment can be interrupted because of adverse drug reaction,virological resistance and high treatment expenditure.Therefore,it is definitely necessary to predict early antiviral efficacy,and timely adjust the treatment plan.IL-21 participates in the innate and adaptive immunity and plays an important role in virus clearance and virus antigen seroconversion in CHB patients.This study dynamically observe the change of serum IL-21 in HBeAg positive CHB patients before and after the use of antiviral drugs,and to explore its predicative function to antiviral treatment effect in HBeAg positive CHB patients,in order to get easy measured serological indexes to guide clinical treatment.Methods:87HBeAg positive CHB patients were recruited from the Third Hospital of Hebei Medical University between February 2012 and January2016,and the treatment and observation duration lasted 96 weeks.The diagnosis of chronic hepatitis B measured up to the standard of Chronic hepatitis B prevention and cure guide(2015 edition)which was set out by The Chinese medical association of liver branch,infection epidemiology branch of Chinese medical association.According to the different clinical application,three treatment groups was divided into:21 cases were treated with entecavir,41 cases were treated with Pegylated IFN or interferon,another 25 cases were treated with Pegylated IFN or interferon combined with entecavir.Serum samples were collected at baseline(0w),12 w,24w,48 w after treatment,and the patients were observed and followed up for 96 weeks.Liver function parameters and serum virological information including HBV DNA loads,the quantification of HBs Ag and HBeAg were determined at the same time.Serum IL-21 concentrations were determined by enzyme-linked immunosorbent assays(ELISA).Results:187 cases of chronic hepatitis B patients were selected,including 41IFN-treating cases,21ETV-treating cases,25 IFN+ETV-treating cases.According the judgment standard,a total of 42 cases of early antiviral response,15 cases of clinical cure,27 cases of complete response,20 cases of partial virological response,25 cases of nonresponse.2 There were no difference among different treatment groups about age,gender,family history,vertical transmission,baseline ALT,baseline HBVDNA,baseline HBs Ag,baseline IL-21,there were no statistical significance(P >0.05).The response were different among different treatment groups,in IFN+ETV-treating group with the highest incidence of CR.There were no statistically significant difference among the rate of CC(P > 0.05),but the rate of CC in IFN-treating group was higher than others,and the rate of CC in IFN+ETV-treating group was higher than ETV-treating group.The incidence of PR in ETV-treating group was higher than anther two groups(P<0.05).The incidence of PR in IFN-treating group was higher than anther two groups(P<0.05).3 There were no difference among different response groups about age,gender,family history,vertical transmission,baseline ALT and baseline HBVDNA(P > 0.05);but the level of baseline HBs Ag,HBeAg,baseline IL-21 were statistically significant difference(P< 0.05).Baseline serum HBs Ag were lower in the CC and CR group than PR and NR group(P < 0.05).Baseline serum HBeAg were lower in the CC group than a CR,PR and NR group(P <0.05).Baseline serum IL-21 were higher in the CC and CR group than PR and NR group(P< 0.05),and baseline serum IL-21 in the CC group was higher than in CR group.4 There were difference when comparing that the serum IL-21 level at12 week,24week,48 week with that at 0week in every treatment groups(P<0.05).The level of serum IL-21 were gradual decline among different treatment groups and the decent degree at 12-week,24 week observation point were different and the decent degree in IFN+ETV-treating group were higher than others(P<0.05).5 There were statistical difference with the baseline serum IL-21 level in different response groups,the serum IL-21 level in clinical cure was higher than others(P<0.05).There were difference when comparing that the serum IL-21 level at 12 week,24week,48 week with that at 0week in every treatment groups(P < 0.05).The level of serum IL-21 were gradual decline among different response groups and the decent degree at 12-week,24 week observation point were different(P<0.05).The decent degree in CC group at 12 week,24week,48 week were higher than others(P<0.05).The decent degree in CC group at 12 week,24week,48 week were higher than PR and NR groups(P<0.05).6 The forecast factors analysis for antiviral response6.1 The forecast factors analysis for early antiviral response Univariate logistic analysis showed that treatment,the serum IL-21,HBVDNA and HBs Ag level at 0week were associated with early antiviral response.While multivariate analysis showed that treatment,the serum IL-21 and HBs Ag level at 0week were predictive factors related to early antiviral response.6.2 The forecast factors analysis for complete response Univariate logistic analysis showed that treatment,the serum IL-21 level at 0week,the serum HBVDNA and IL-21 decent degree at12 week,the serum HBs Ag level at 24 week were associated with complete response.While multivariate analysis showed that treatment,the serum IL-21 level at 0week,the serum IL-21 decent degree at12 week,the serum HBs Ag level at 24 week were predictive factors related to complete response.6.3 The forecast factors analysis for clinical cure Univariate logistic analysis showed that treatment,the serum IL-21 level at 0week,the serum HBV DNA level,HBs Ag level and IL-21 decent degree at12 week,the serum HBs Ag level and IL-21 decent degree at 24 week were associated with complere cure.While multivariate analysis showed that the serum HBs Ag and IL-21 level at 0 week?the decent degree of serum IL-21 and the serum HBs Ag level at 12 weeks were the predictive factors for clinical cure.Conclusions:1 The serum IL-21 levels in HBeAg positive chronic hepatitis B patients after antiviral treatment were gradual decline;the high level of serum IL-21 at baseline,the level and decent degree at 12 week and 24 week after antiviral treatment were better predictive value for evaluating early antiviral response,clinical cure and complete response.2 The decent degree and rate of serum IL-21 in HBeAg positive chronic hepatitis B patients after antiviral treatment were associated with treatment,and the decent rate of serum IL-21 in the IFN+ETV-treating group was higher than IFN-treating and ETV-treating,and with the highest HBeAg seroconversion rate. |
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