标题：干扰素α-1b联合替比夫定序贯治疗慢性乙型肝炎的疗效及其对患者 sPD-1和 sICOS水平的影响

      作者：陈俊，张玲玲，刘俊英    
(眉山市人民医院感染科，四川 眉山 620010)

      卷次： 2016年27卷13期

      【摘要】 目的 观察干扰素α-1b (IFNα-1b)联合替比夫定序贯治疗乙型肝炎的疗效，并探讨其对患者血清中可
溶性程序性死亡蛋白1 (sPD-1)和可溶性可诱导共刺激分子(sICOS)水平的影响。方法 选取我院2012年1月至2013
年5月符合条件的患者80例，按随机数表法随机分为观察组和对照组，每组40例。两组患者均给予 IFNα-1b治疗，
50 g/次，隔日1次，肌内注射。对照组继续给予 IFNα-1b巩固治疗，用量同前，疗程12个月。观察组口服替比夫定序贯
治疗，600 mg/次，1次/d，疗程12个月。比较两组患者治疗后的应答有效率以及治疗前后的血清sPD-1和sICOS水平，
检测两组患者的门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)及γ-谷氨酸酰基转移酶(GGT)，并参照慢性肝
病量表(CLDQ)评价生活质量。结果 观察组患者的完全应答率和部分应答率分别为 50.0% (20/40)和 37.5%
(15/40)，均高于对照组的40.0% (16/40)和25.0% (10/40)，差异均有统计学意义(P<0.05)；观察组患者治疗后的CLDQ
量表各项评分均明显高于对照组，差异均有显著统计学意义(P<0.01)；观察组治疗后AST [(26.56±2.85) U/L]、
ALT [(30.28±3.23) U/L]和GGT [(34.26 ±3.58) U/L]水平均显著低于对照组(P<0.01)；观察组治疗后血清中 sPD-1和
sICOS水平分别为 (404.27±41.26) pg/mL和 (35.78±3.91) pg/mL，均明显低于对照组的 (517.91±52.55) pg/mL和
(44.36±4.56) pg/mL，差异均有显著统计学意义(P<0.01)。结论 IFNα-1b联合替比夫定序贯治疗乙型肝炎可明显改
善患者生活质量，提高应答总有效率，其抑制患者血清中 sPD-1和 sICOS水平表达可能在治疗中发挥重要作用。

      【关键词】 干扰素α-1b；替比夫定；慢性乙型肝炎；可溶性程序性死亡蛋白1；可溶性可诱导共刺激分子

      【中图分类号】 R512.6+2 【文献标识码】 A 【文章编号】 1003—6350（2016）13—2104—04


Curative effect and mechanism analysis of ordinary interferon combined with telbivudine in sequentially treating
patients with chronic hepatitis B.
CHEN Jun, ZHANG Ling-ling, LIU Jun-ying. Meishan City People's Hospital of
Infectious Diseases, Meishan 620010, Sichuan, CHINA

【Abstract】 Objective To observe the clinical efficacy of ordinary interferon alpha-1b (IFNα-1b) combined
with telbivudine in sequentially treating patients with chronic hepatitis B and its effect on serum soluble apoptosis pro-
tein 1 (sPD-1) and soluble inducible costimulatory molecule (sICOS). Methods According to the random number ta-
ble method, a total of 80 eligible cases, who admitted to our hospital from January 2012 to May 2013, were randomly di-
vided into control group and treatment group, with 40 cases in each group. Patients in both groups received IFNα-1b by
intramuscular injection once every two days (50 g each time). The control group was given consolidation therapy of IFN
α-1b for 12 months; The treatment group was given telbivudine in sequential treatment for 12 months (600 mg each
time). Response rates after treatment were compared and serum sPD-1 and sICOS were detected in both groups before
and after treatment. Indexes of liver function aspartate aminotransferase (AST), alanine aminotransferase (ALT), and
γ-glutamyl transpeptidase (GGT) were measured in two groups. Life treatment evaluations in both groups were com-
pared according to Chronic Liver Disease Questionnaire (CLDQ). Results Complete response rate [50.0% (20/40)]
and part response rate [37.5% (15/40)] in treatment group were higher than those in control one [40.0% (16/40),
25.0% (10/40), respectively] with statistical difference (χ2=4.418, P<0.05). After treatment, scores of CLDQ in treatment
group were evidently higher than control one (P<0.01); Levels of AST [(26.56±2.85) U/L], ALT [(30.28±3.23) U/L], and
GGT [(34.26±3.58) U/L] in the treatment group were significantly lower than those in control group after treatment
(P<0.01). After treatment, levels of serum sPD-1 [(404.27±41.26) pg/mL] and sICOS [(35.78±3.91) pg/mL] in the
treatment group were obviously lower than control group [(517.91±52.55) pg/mL, (44.36±4.56) pg/mL, respectively]
with statistical difference (P<0.01). Conclusion Ordinary interferon combined with telbivudine in sequentially treat-
ing patients with chronic hepatitis B could notably improve patients' life quality and increase the response efficient rates.
Its role may be related to suppressing the levels of sPD-1 and sICOS in serum.

      【Key words】 Interferon alpha-1b (IFN α-1b); Telbivudine; Chronic hepatitis B; Soluble apoptosis protein 1
(sPD-1); Soluble inducible costimulatory molecule (sICOS)
·论 著·
6350.2016.13.014