中文摘要：

目的探讨聚乙二醇干扰素仅治疗HBeAg阳性慢性乙型肝炎患者的疗效及肝脏病理学特征等因素对HBeAg血清学转换的影响。方法80例HBeAg阳性慢性乙型肝炎患者治疗前均行肝穿刺术，皮下注射Peg-IFNα，每周1次，治疗48周，随访24周。治疗结束后统计HBeAg的血清学转换情况，并结合肝脏病理学特征及性别、年龄、ALT、HBeAg半定量、HBVDNA定量等基线指标分析影响HBeAg血清学转换的相关因素。用多变量二分类logistic回归分析方法分析HBeAg血清学转换的影响因素。结果80例患者治疗48周时血清学转换率为30．00％（24／80），其中22例肝组织炎症活动度为G1，HBeAg血清学转换率为9．09％；38例为G2，HBeAg血清学转换率为31．58％；19例为G3，HBeAg血清学转换率为47．3％；1例为G4，HBeAg成功转换。随着炎症活动度的升高，HBeAg血清学转换率逐步升高（X2=8．435，P=0．015）；而肝组织纤维化程度与HBeAg血清学转换率无显著相关性（X2=5．917，P=0．116）。性别、年龄、ALT、HBVDNA等基线指标在HBeAg血清学转换组与未转换组的差异无统计学意义（P值均〉0．05）。多变量二分类logistic回归分析结果显示，诸因素中仅肝组织炎症活动度（G）与HBeAg半定量为疗效影响因素。结论HBeAg阳性慢性乙型肝炎肝组织炎症活动度高者聚乙二醇干扰素α治疗HBeAg血清学转换率较高，建议对需要治疗的患者应尽可能先行肝活组织检查。

英文摘要：

Objective To investigate the therapeutic efficiency of antiviral treatment with pegylated- interferon （Peg-IFN） for hepatitis B e antigen （HBeAg）-positive chronic hepatitis B （CHB） and to explore whether liver histopathological features or other factors influence the HBeAg seroconversion treatment response. Methods Eighty HBeAg-positive CHB patients with diagnosis confirmed by liver puncture were treated with Peg-IFN（2α or 2β）body weight dose, once weekly）. At treatment week 48, the rate of HBeAg seroconversion was determined and used to analyze the influence of liver histopathological features （liver biopsy assessment of： inflammation, graded GO to G4; fibrosis stage, graded SO to S4）, sex, age, differential levels （pre-treatment baseline vs. week 48 post-treatment） of serum alanine transferase （ALT）, and HBVDNA, by binary logistic analysis. Results At week 48, the overall rate of HBeAg seroconversion was 30.0%. The rate of HBeAg seroconversion gradually advanced with increased liver inflammation （2＇2 = 8.435, P = 0.015）： 9.09% of the 22 patients with G1; 31.58% of the 38 patients with G2; 47.30% of the 19 patients with G3; the one patient with G4. In contrast, the rate of HBeAg seroconversion showed a much weaker association with liver fibrosis （X2 = 5.917, P = 0.116）. Only baseline HBeAg level, and no other baseline index, was significantly different between the patients who achieved HBeAg seroconversion and those who did not. Liver inflammation and baseline HBeAg level were identified as influencing factors of HbeAg seroconversion in response to Peg-IFN treatment. Conclusion Peg-IFN therapy induces a higher rate of HBeAg seroconversion in HBeAg-positive CHB patients with severe liver inflammation; histological analysis ofpre-treatment liver biopsies may help to identify patients most likely to benefit from the antiviral regimen.