Efficacy And Influencing Factors Of PEG IFN-α-2b In The Treatment Of Patients With Chronic Hepatitis B In The Real World

Objective: To investigate the efficacy and influencing factors of PEG IFN-α-2b in the treatment of chronic viral hepatitis B patients in the real world.Methods: carried out a prospective observation study on 87 patients infected with Xinjiang Medical University First Hospital.According to the clinical cure and HBe Ag seroconversion after 48 weeks of PEG IFN-α-2b treatment,the patients were divided into clinical cure group,no clinical cure group,seroconversion group and no seroconversion group The efficacy and clinical cure of PEG IFN-α-2b,the influencing factors of HBe Ag seroconversion,and the safety of PEG IFN-α-2b were evaluated.Results: After 48 W treatment with PEG IFN-α-2b,the rate of clinical cure in patients with HBe Ag was 39.1%,the clinical rate of treatment of HBe Ag positive patients was 13.1%,and the difference in both groups was statistically significant(P<0.05).The clinical rate of treatment of polyethylene glycol interferon α-2b was 46.7%,and the clinical healing rate of the nucleotide was 24.6%,and the difference was statistically significant(P<0.05);analysis of baseline data for patients with different treatment regimens,and baseline HBs Ag levels in single use patients were lower than those in the patients with a single use,the HBe Ag negative rate was higher than that of patients with combined use,the difference was statistically significant(P<0.05),suggesting that the baseline low level of HBs Ag And HBe Ag negative patients with PEG IFN-α-2b alone can obtain good therapeutic effect.Stratified discussion of different levels of baseline HBs Ag treatment,the highest clinical cure rate was 41.27% when HBs Ag≤1500IU/ ml;there was no clinical cure in patients with HBs Ag > 5000 IU / ml,The difference of the clinical cure rate was statistically significant(P<0.05).Baseline age and treatment were significantly different,HBs Ag level,HBe Ag status,HBV DNA status and ALT level between the clinically cured group and the non clinically cured group(P<0.05).The age and baseline HBs Ag level of the clinically cured group were lower than those of the non clinically cured group;HBe Ag negative,The clinical hardening group HBV DNA level and ALT water are lower than average non ‐ hardened groups.The clinical cure rate of DNA negative patients is higher than that of DNA positive patients.;Patients with high baseline ALT tended to undergo clinical treatment,WBC,neutrophil,platelet count between clinical cure group and non clinical cure group(P>0.05).During treatment and follow-up,the decrease level of HBs Ag in the clinical healing group was higher than that of the non ‐ clinic cure group.The difference between two groups in 12 W and 24 W was statistically significant(P<0.05).The ALT and AST values of the two groups were significantly higher than the baseline.The ALT level between baseline and 12 W group was also statistically significant(P<0.05).The difference of white blood cells between 12 W and 24 W groups was statistically significant(P<0.05).Further analysis of logistical regression showed its age(OR=0.897,P<0.05),baseline HBs Ag level(OR=0.082,P<0.05),HBV DNA status(OR=4.225,P<0.05),baseline ALT level(OR=1.051,P<0.05),12 W HBs Ag level(OR=0.308,P<0.05)and 24 W HBs Ag level(OR=0.226,P<0.05)during follow-up were the factors influencing the use of PEG IFN-α-2b The independent influencing factors of clinical cure after 48 W.ROC curve analysis showed that the best cutoff value of age for predicting the clinical cure was 51 years old.,AUC was 0.644(95% confidence interval: 0.534-0.744),sensitivity was 100%,specificity was 23.73%;the best cutoff value of ALT for predicting clinical cure was 33.24u/l,AUC was 0.719(95% confidence interval: 0.612-0.810),sensitivity was 67.86%,specificity was 72.88%;baseline,12 W,24W The best cutoff values of HBs Ag for predicting clinical cure were 111.98 IU/ml(AUC: 0.822,95%confidence interval: 0.725-0.896),85.79IU/ml(AUC: 0.877,95% confidence interval:0.789-0.938)and 0.193 IU/ml(AUC: 0.950,95% confidence interval: 0.879-0.986),respectively.By analyzing the baseline and follow-up changes of 23 HBe Ag positive patients in seroconversion group and non conversion group after 48 weeks of treatment,we can know that the baseline and early follow-up changes of age,gender,treatment regimen,HBV infection rate were significantly different There were no significant differences in DNA status,HBs Ag level,HBe Ag level,alt,AST level,WBC,neutrophil and platelet count between HBe Ag seroconversion group and non conversion group(P>0.05).The safety of treatment was evaluated with PEG The common adverse reactions of PEG IFN-α-2b were fever,myelosuppression,and elevated transaminase.In the early stage,64.9% of the patients had fever symptoms;about 60.9% of the patients had myelosuppression,such as leukopenia,neutropenia,and thrombocytopenia;58.1% of the patients had elevated transaminase;26.4% of the patients had headache,joint,muscle soreness and other discomfort;and a few patients had rash The adverse reactions included hair loss(6.8%),weight loss(4.6%),sleep disorders(6.9%),thyroid dysfunction(2.3%),etc.the adverse reactions were safe and controllable,tolerable and safe.Conclusion:1.The clinical cure rate of HBe Ag negative patients is higher than that of HBe Ag positive patients.2.Patients with low baseline HBs Ag and Negative HBe Ag can get good therapeutic effect by using PEG IFN-α-2b alone.3.Clinical cure rate of HBV DNA negative patients is higher than HBV DNA positive patients,and HBV DNA status is an independent factor affecting clinical cure,HBV DNA negative patients are more likely to get clinical cure.4.Age is an independent influencing factor of clinical cure.When PEG IFN-α-2b is used,the younger the age is,the easier the clinical cure is.Age<51 can predict the clinical cure after 48 weeks of treatment.5.Baseline ALT level is an independent influencing factor of clinical cure.High baseline ALT level indicates more clinical cure.Baseline ALT>33U/L can predict clinical cure after 48 W of treatment.6.The clinical cure rate of baseline HBs Ag<1500IU/ml was the highest.The level of HBs Ag at baseline,12 W and 24 W was the independent influencing factor of clinical cure.Baseline HBs Ag<111.98IU/ml,12 W HBs Ag<85.79 IU /ml and 24 W HBs Ag<0.193IU/ml could predict clinical cure after 48 W treatment.7.PEG IFN-α-2b is effective in the treatment of patients with chronic hepatitis B,the adverse reactions are safe and controllable,and can be tolerated with high safety.