Efficacy And Prognostic Factors Of PEG-IFN-α-2b In The Treatment Of Chronic Hepatitis B And Hepatitis B Related Cirrhosis

Objective: This study was conducted to investigate the effect and prognostic factors of PEG-IFN-α-2b in the treatment of chronic hepatitis B and hepatitis B related cirrhosis,and to further provide clinical theoretical basis and guidance for patients.Method:Patients with hepatitis B and hepatitis B related cirrhosis who were treated in outpatient and inpatient Department of Infection,the First Affiliated Hospital of Xinjiang Medical University were selected and treated with PEG-IFN-α-2b for 48 weeks.Clinical biochemical and HBV serological indexes were tested at baseline and every 12 weeks.Blood routine examination and imaging examination were performed according to patients’ conditions.The therapeutic effect of PEG-IFN-α-2b and its influencing factors were analyzed.The clinical cure,HBe Ag serological conversion and adverse events were compared between the two groups,and the related factors affecting the clinical cure of patients with hepatitis B and cirrhosis were analyzed.Results:(1)159 patients completed48 weeks of treatment and follow-up,a total of 51 patients were cured,the overall clinical cure rate was 32.07%;The clinical cure rate of HBe Ag-negative patients was 36.75%(43/117),and that of HBe Ag-positive patients was 19.05%(8/42).The difference in cure rate between the two groups was statistically significant(P < 0.05).Among the 42 HBe Ag-positive patients,18 patients obtained serological conversion(42.86%).The clinical cure rate of HBV-DNA negative patients was 34.19%(40/117),and that of HBV-DNA positive patients was 26.19%(11/42).There was no significant difference in the cure rate between the two groups.(2)Among 135 patients with hepatitis(101 HBe Ag negative and 34 HBe Ag positive),44 were cured(37 HBe Ag negative and 7 HBe Ag positive),the clinical cure rate was 32.57%,and 14 patients had HBe Ag serological conversion(41.18%).Of 24 patients with cirrhosis(16 HBe Ag-negative and 8HBe Ag-positive),7 were clinically cured(6 HBe Ag-negative and 1 HBe Ag-positive),the clinical cure rate was 29.17%,and 4 had HBe Ag serologic conversion(50.00%).There was no significant difference in clinical cure rate and serological conversion rate between hepatitis group and cirrhosis group.(3)Of the clinically cured patients,30 occurred within48 weeks,18 occurred after 48 weeks of extended therapy,3 occurred after interferon discontinuation,and 4 developed HBs Ag relapse(3 patients with hepatitis and 1 patient with cirrhosis).(4)In the course of treatment,liver cirrhosis did not develop in the patients with hepatitis B,and liver cancer occurred in one patient.Decompensation occurred in one patient with cirrhosis.There were no interferon-related deaths or serious complications in both groups.(5)During the treatment,leukocytes,neutrophils and platelets were decreased in both the hepatitis group and the cirrhosis group,and the reduction of platelets in the cirrhosis group was greater,and the difference between the two groups was statistically significant(P < 0.05).Aminotransferase increased in both groups,but there was no statistical significance between the two groups.However,the overall blood routine and liver function were within the safe range,and could be improved after a short time of drug withdrawal or drug therapy.(6)The baseline HBs Ag level and HBe Ag status of clinically cured patients were significantly different(P < 0.05),and the baseline HBs Ag level of clinically cured patients was lower than patients who are not clinically cured;The clinical cure rate of HBe Ag-negative patients was higher than that of positive patients.(7)Baseline HBs Ag level was predictive of negative HBs Ag conversion after Peg-IFN-α-2b treatment.For the hepatitis group,the AUC was 0.780,the optimal cut-off value was145.71IU/ml,the sensitivity was 76.7%,and the specificity was 69.8%.For cirrhosis group,the AUC was 0.950,the optimal cut-off value was 85.84IU/ml,the sensitivity was94.1%,and the specificity was 85.7%.Conclusion:PEG-IFN-α-2b is safe in the treatment of chronic hepatitis B and compensatory hepatitis B relaxed cirrhosis,and the therapeutic efficacy of the two groups is similar.However,the proportion and severity of adverse reactions in patients with cirrhosis are higher and more severe during treatment,and there is the possibility of liver decompensation.HBe Ag status was an independent factor affecting clinical cure,and the clinical cure rate of HBe Ag negative patients was higher than that of HBe Ag positive patients.Low baseline HBs Ag levels predicted clinical recovery at the end of the 48-week course of treatment.