基线HBsAg和ALT水平是替比夫定治疗HBeAg阳性慢性乙型肝炎患者e抗原血清学转换的重要预测因素

目的评价初治、单药使用替比夫定治疗HBeAg阳性的慢性乙型肝炎（CHB）患者48周的e抗原血清学转换的基线预测因素。方法97例HBeAg阳性CHB患者分别以基线HBsAg、ALT和HBVDNA水平高低分组，对比两组治疗48周时生化学、病毒学和血清学应答情况。结果基线HBsAg-101500IU／mL组e抗原阴转率和血清学转换率均为42．3％，基线HBsAg〉1500IU／mL组分别为20％和17．8％，两组比较差异均有统计学意义（P〈0．05）；基线ALT〉5ULN组e抗原阴转率和血清学转换率均为45．1％，基线ALT05ULN组分别17．4％和15．2％，两组比较差异均有统计学意义（P〈0．01）；基线HBVDNA〈8．0log-10copies／mL组和基线HBVDNA≥8．0log-10copies／mL组e抗原阴转率和血清学转换率相比，差异无统计学意义（P〉0．05）；基线水平HBsAg≤1500IU／mL且ALT〉5ULN的CHB患者共40例作为观察组，其余57例患者作为对照组，治疗48周时观察组e抗原阴转率和血清学转换率均为45％，对照组分别为22．8％和21．1％，两组比较差异均有统计学意义（P〈0．05）。结论基线HBsAg水平≤1500IU／mL和ALT水平〉5ULN的HBeAg阳性慢性乙型肝炎患者，在接受替比夫定治疗48周时，有较高的e抗原转阴率和血清学转换率；基线HBsAg和ALT水平是替比夫定治疗e抗原血清学转换的重要预测因素。

Baseline HBsAg and ALT levels are important forecasting factors of HBeAg seroconversion in HBeAg positive chronic hepatitis B treated with telbivudine

Objective To evaluate the baseline forecasting factor of HBeAg seroconversion withtelbivudine （LDT） monotherapy in treatment-naive HBeAg-positive chronic hepatitis B （CHB） patients for 48 weeks. Methods Ninety-seven HBeAg-positive CHB patients were divided into two group according to the baseline levels of HBsAg, ALT and HBVDNA; and the biochemical, virological, serological profiles at Week 48 were compared between the two groups. Results The group with baseline levels of HBsAg ≤ 1500 IU/mL showed higher rates of HBeAg nega- tive （42.3% vs 20% ; P 〈 0.05） and HBeAg seroconversion （42.3% vs 17.8% ; P 〈 0.05） ; the group with baseline levels of ALT 〉5 ULN showed higher rates of HBeAg negative （45. 1% vs 17.4% ; P 〈0. O1） and HBeAg seroeonversion （45.1% vs 15.2% ; P 〈0.01 ）. Comparison between the group with baseline levels of HB-VDNA ≤ 7.9 logl0 copies/mL and the group with HBVDNA ≥ 8.0 lOgl0 copies/mL showed no significant differ- ence in the rates of HBeAg negative and seroconversion （ P 〉 0.05 ） ; the group with baseline levels of HBsAg ≤ 1 500 IU/mL and ALT 〉 5 ULN showed higher rates of HBeAg negative （45% vs 22. 8% ; P 〈 0.05 ） and HBeAg seroconversion （45% vs 21.1% ; P 〈 0.05 ）. Conclusion CHB patients accepted LDT treatment with Low base- line HBsAg level （ ≤ 1500 IU/mL） and high baseline ALT level （ 〉 5 ULN） presented satisfactory responses of HBeAg negative and HBeAg seroeonversion at week 48 ; baseline HBsAg and ALT levels are important forecasting factors of HBeAg seroeonversion with the treatment of telbivudine （LDT）.