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From November 2017 to November 2018, 221 of 250 HBeAg-positive chronic hepatitis B patients in the Second Department of Hepatology, Beijing Ditan Hospital Affiliated with Capital Medical University gave written informed consent to enter our study group, and 29 patients could not be followed up continuously at home. Of these 221 patients with CHB, 116 were treated with PEG-IFN-2a, and 105 cases were allocated to the oral ETV treatment group. Three patients in the PEG-IFNα-2a group withdrew from the study because they could not tolerate the side effects of PEG-IFNα-2a, five patients withdrew from the study because they were ready to conceive, and eight patients did not complete the 48-week follow-up. One patient in the ETV group withdrew because of the side effect of elevated lactate, and four patients did not complete the 48-week follow-up. Finally, a total of 200 CHB patients completed the 48-week follow-up, including 100 patients in the PEG-IFN-2a treatment group and 100 patients in the ETV treatment group, as shown in Figure 1. The age of the patients ranged from 28 to 38 years, comprising 121 males and 79 females. In the PEG-IFN-2a group, 55 patients were treated with ETV after 12 weeks of PEG-IFN-2a treatment, and 10 patients were treated with ETV after 24 weeks. Age, white blood cell counts, HGB, PLT, biochemical indicators (ALT, AST, TBil, ALB), and virological indicators (HBV DNA load, HBsAg level, HBeAg level) of the two groups are shown in Table 1. There were no significant differences in age, WBC, HGB, PLT, ALT, AST, TBil, ALB, HBV DNA load, HBsAg level, and HBeAg level between the two groups. The baseline cytokine characteristics between the two groups were analyzed, and the results are shown in Table 1 and Figure 2. There was a statistically significant difference in TNF-α between the PEG-IFN and ETV groups (17.93 vs. 8.79 PG/mL, Z = −4.589, P < 0.001). Other cytokines were not significantly different.
Clinical characteristics Total patients (n = 200) PEG-IFN (n = 100) ETV (n = 100) Z/χ2 P Male (%) 121 (60.5%) 60 (60%) 61 (61%) χ2 = 0.021 0.885 Age (y) (median, range) 32 (28–38) 31 (28–36) 32 (28–38) Z = 0.718 0.473 ALT (U/L) (median, range) 232.95 (126.45–353.70) 240.70 (129.30–359.25) 227.70 (123.03–345.20) Z = −0.204 0.838 AST (U/L) (median, range) 108.70 (61.95–173.98) 121.50 (65.60–172.35) 103.35 (61.10–181.60) Z = −0.739 0.460 TBil (µmol/L) (median, range) 14.30 (11.60–20.40) 13.25 (11.80–18.23) 15.70 (11.60–21.58) Z = −1.679 0.093 ALB (g/L) (median, range) 45.50 (42.60–47.40) 45.25 (42.70–47.10) 45.70 (42.30–47.90) Z = −0.400 0.689 HBsAg (log10 IU/mL) (median, range) 3.88 (3.63–4.10) 3.88 (3.63–4.10) 3.88 (3.63–4.10) Z = −0.051 0.959 HBeAg (S/CO) (median, range) 852.62 (472.32–1188.79) 859.25 (488.81–1193.45) 811.69 (452.44–1173.23) Z = −0.071 0.944 HBV DNA (log10 IU/mL) (median, range) 6.66 (6.34–7.31) 6.66 (6.26–7.31) 6.65 (6.40–7.37) Z = −0.088 0.930 WBC (109/L) (median, range) 5.07 (4.56–5.82) 5.02 (4.48–6.24) 5.07 (4.74–5.65) Z = −0.522 0.602 HGB (g/L) (median, range) 151.50 (140.00–163.00) 150.00 (142.25–161.00) 153.00 (136.75–165.85) Z = −0.535 0.592 PLT (109/L) (median, range) 178.50 (154.00–220.50) 180.00 (147.50–222.00) 175.10 (159.00–219.00) Z = −0.270 0.787 Flt3-L (pg/mL) (median, range) 16.49 (0.53–82.42) 16.49 (0.56–83.56) 0.14 (0.02–30.77) Z = −1.607 0.108 IFN-α2 (pg/mL) (median, range) 42.66 (21.12–76.52) 41.60 (19.75–86.86) 42.66 (26.46–74.17) Z = −0.622 0.534 IFN-γ (pg/mL) (median, range) 21.27 (6.46–61.48) 22.47 (8.39–62.15) 20.16 (3.92–58.41) Z = −1.365 0.172 IL−10 (pg/mL) (median, range) 9.07 (3.94–18.61) 9.04 (3.32–19.26) 9.07 (4.94–18.31) Z = −0.04 0.968 IL-17A (pg/mL) (median, range) 5.60 (2.75–36.75) 7.16 (3.21–37.39) 5.20 (2.74–36.75) Z = −0.903 0.367 IL-6 (pg/mL) (median, range) 2.27 (0.90–7.58) 2.15 (1.01–8.27) 2.46 (0.84–6.33) Z = −0.986 0.324 TNF-α (pg/mL) (median, range) 9.72 (7.42–16.62) 17.93 (14.76–43.36) 8.79 (6.61–14.73) Z = −4.589 < 0.001 TGF-β1 (pg/mL) (median, range) 4079.00
(2584.00–7503.75)4794.50
(2911.00–8057.25)5167.00
(2553.00–7885.00)Z = −0.797 0.426 TGF-β2 (pg/mL) (median, range) 425.81 (351.88–698.40) 435.48 (355.05–716.21) 412.21 (224.29–537.31) Z = −1.226 0.220 TGF-β3 (pg/mL) (median, range) 160.09 (133.50–207.50) 156.35 (131.69–200.38) 173.92 (160.74–209.12) Z = −1.506 0.132 Table 1. Clinical characteristics of the PEG-IFN and ETV groups
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Figure 2 shows that, in the PEG-IFN group, the level of Flt3-L decreased, and the levels of IFN-γ, IL-10, IL-17A, IL-6, and TGF-β1 decreased significantly after 3 and 6 months of treatment, as compared with baseline (IFN-γ: 1.355 vs. 1.08 and 0.84 PG/mL, P < 0.001; IL-10: 0.97 vs. 0.465 and 0.41 pg/mL, respectively, P < 0.001; IL-17A: 0.855 vs. 0.54 and 0.52 PG/mL, P < 0.001; IL-6: 0.33 vs. 0.15 and 0.04 PG/mL, P < 0.001; TGF-β1: 13.61 vs. 3.47 and 3.395 PG/mL, P < 0.001); IFN‐α2 levels were significantly higher (1.62 vs. 2.66 and 2.69 PG/mL, P < 0.001). In the ETV treatment group, the levels of Flt3-L, IL-17A, and IFN‐α2 increased, while those of IFN-γ and IL-6 decreased, but there was no statistical difference (P = 0.903, 0.284, 0.099, 0.368, 0.795, respectively); IL-10 levels decreased significantly (0.96 vs. 0.82 and 0.74 pg/mL, P < 0.001); and TGF-β1 levels decreased significantly (3.61 vs. 3.05 and 2.605 PG/mL, P < 0.001).
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We analyzed the clinical characteristics of the PEG-IFN and ETV groups during treatment (Table 2). At baseline, there was a statistically significant difference in TNF-α between the PEG-IFN and ETV groups, but there were no statistically significant differences in biochemical indexes (ALT, AST, TBil, ALB), virological indexes (HBV DNA, HBsAg, HBeAg), or other cytokine levels. After 3 months of treatment, the biochemical and virological indexes were statistically significantly different between the PEG-IFN and ETV groups. The levels of IFN‐α2, IL-10, IL-17A, IL-6, TNF-α, TGF-β1, and TGF-β3 differed significantly between the PEG-IFN and ETV groups. After 6 months of treatment, there were statistically significant differences between the PEG-IFN and ETV groups in biochemical indexes, virological indexes, and cytokines, except ALB and Flt3-L. After 9 months of treatment, the biochemical and virological indexes between the PEG-IFN group and the ETV group were significantly different. After 12 months of treatment, there was no significant difference in ALB between the PEG-IFN and ETV groups, while other biochemical and virological indexes were significantly different.
Indicators 12 weeks 24 weeks 36 weeks 48 weeks PEG-IFN ETV Z/P PEG-IFN ETV Z/P PEG-IFN ETV Z/P PEG-IFN ETV Z/P ALT (U/L)
(median, range)68.10
(48.25–86.80)33.30
(22.40–53.25)−5.796/
< 0.00143.90
(26.90–60.80)22.80
(17.75–35.95)−5.869/
< 0.00134.90
(28.05–52.93)23.00
(16.90–28.90)−6.312/
< 0.00129.80
(17.70–46.30)21.10
(15.30–28.78)−3.335/
0.001AST (U/L)
(median, range)44.00
(32.05–55.20)28.10
(19.90–35.50)−6.544/
< 0.00136.80
(26.00–55.80)22.50
(17.90–28.05)−7.036/
< 0.00131.70
(24.40–41.65)21.00
(16.60–25.40)−7.412/
< 0.00126.70
(19.78–35.60)20.80
(16.80–24.55)−3.785/
< 0.001TBil (µmol/L)
(median, range)11.80
(9.50–13.80)12.70
(9.30–18.50)−1.973/
0.0489.70
(7.90–11.90)12.30
(9.30–15.85)−4.234/
< 0.00110.25
(7.60–12.50)12.90
(9.85–15.85)−4.643/
< 0.00110.40
(8.10–12.80)12.35
(9.90–15.28)−3.779/
< 0.001ALB (g/L)
(median, range)46.30
(44.10–48.60)47.70
(44.50–49.15)−2.201/
0.02846.50
(43.90–49.00)47.65
(45.60–49.10)−1.714/
0.08747.10
(43.65–49.20)48.50
(46.18–49.90)−2.900/
0.00447.10
(45.40–50.30)48.50
(46.50–49.80)−1.271/
0.204HBsAg (log10 IU/mL)
(median, range)3.42
(2.90–3.82)3.68
(3.44–4.04)−4.220/
< 0.0013.14
(2.55–3.72)3.82
(3.34–4.02)−5.670/
< 0.0013.06
(2.49–3.77)3.76
(3.35–3.99)−5.229/
< 0.0013.33
(2.56–3.78)3.68
(3.27–3.95)−3.812/
< 0.001HBeAg (S/CO)
(median, range)48.87
(9.60–245.70)77.77
(14.80–689.49)−2.037/
0.04213.72
(2.81–64.64)63.58
(6.34–398.52)−3.926/
< 0.0017.45
(0.65–40.28)48.36
(3.90–217.58)−4.252/
< 0.0016.64
(0.56–23.95)17.24
(3.52–107.30)−4.351/
< 0.001Flt3-L (pg/mL)
(median, range)2.34
(0.16–27.82)1.25
(0.02–55.67)−0.276/
0.7971.49
(0.24–24.53)2.24
(0.02–78.56)−0.078/ 0.949 / / / / / / IFN-α2 (pg/mL) 442.33
(283.34–704.36)32.35
(25.16–72.34)−8.617/
< 0.001554.67
(267.50–661.44)97.83
(82.04–110.93)−9.051/
< 0.001/ / / / / / IFN-γ (pg/mL)
(median, range)16.20
(9.06–27.82)3.29
(1.54–139.11)−1.935/
0.05311.90
(5.48–26.40)5.07
(3.39–95.40)−2.601/
0.009/ / / / / / IL−10 (pg/mL)
(median, range)2.83
(1.23–4.82)3.62
(2.49–288.46)−2.301/
0.0213.08
(1.42–8.64)8.90
(2.01–142.65)−2.384/
0.017/ / / / / / IL-17A (pg/mL)
(median, range)4.70
(2.31–10.92)3.50
(1.61–46.01)−3.181/
0.0014.27
(2.05–10.92)9.44
(3.62–16.41)−2.648/
0.008/ / / / / / IL-6 (pg/mL)
(median, range)1.75
(0.92–2.69)1.89
(1.72–7.05)−4.066/
< 0.0011.37
(0.71–2.42)2.45
(1.44–6.66)−5.796/
< 0.001/ / / / / / TNF-α (pg/mL)
(median, range)18.14
(14.05–20.85)1.90
(0.81–3.86)−6.562/
< 0.00114.66
(11.99–18.14)1.92
(1.02–2.92)−6.715/
< 0.001/ / / / / / TGF-β1 (pg/mL)
(median, range)2959.00
(1686.75–4895.00)8.85
(6.36–14.05)−12.143/
< 0.0012487.50
(913.49–5182.25)9.58
(7.49–13.08)−11.895/
< 0.001/ / / / / / TGF-β2 (pg/mL)
(median, range)430.51
(319.85–600.46)NA NA 342.62
(270.20–463.54)NA NA / / / / / / TGF-β3 (pg/mL)
(median, range)126.86
(115.35–158.56)1125.89
(195.75–3511.06)−6.442/0.001 138.80
(115.80–160.74)406.75
(104.97–2477.75)−3.395/
0.001/ / / / / / Table 2. Comparison of clinical indicators between the PEG-IFN and ETV groups during treatment
The difference in baseline TNF-α levels was statistically significant between the PEG-IFN and ETV groups (Table 1), so we used analysis of covariance. Taking the baseline TNF-α level as a covariate to eliminate the bias of the baseline effect on the results, univariate analysis of covariance for TNF-α showed no significant difference between the two groups at 3 and 6 months after adjustment (F = 1.449, P = 0.231; F = 0.003, P = 0.956, respectively).
Supplementary Table S1 (available in www.besjournal.com) shows an analysis of the correlation between cytokines and dynamic changes in HBsAg in the PEG-IFN and ETV groups. In the PEG-IFN group, the kinetic changes in IFN-α2 and IL-10 at 3 and 6 months were significantly correlated with those of HBsAg (IFN-α2: r = −0.227, P = 0.025; r = −0.262, P = 0.009; IL-10: r = 0.366, P < 0.0012; r = 0.277, P = 0.005); in the ETV group, the kinetic changes in TNF-α at 3 and 6 months were significantly correlated with those of HBsAg (r = 0.226, P = 0.024).
Group Interaction IFN ETV 3 months 6 months 3 months 6 months r P r P r P r P Fit3L*HBsAg 0.159 0.182 −0.017 0.887 0.149 0.542 0.003 0.990 IFNα2*HBsAg −0.227 0.025 −0.262 0.009 0.007 0.945 0.075 0.461 IFNγ*HBsAg 0.084 0.408 0.101 0.319 0.137 0.175 0.035 0.734 IL10*HBsAg 0.366 < 0.0012 0.277 0.005 0.183 0.068 −0.027 0.793 IL17A*HBsAg 0.181 0.075 0.104 0.303 0.143 0.157 −0.046 0.654 IL2*HBsAg −0.117 0.606 −0.065 0.774 0.097 0.338 −0.015 0.882 IL6*HBsAg 0.173 0.089 0.140 0.167 0.097 0.337 −0.082 0.421 TNFα*HBsAg 0.226 0.338 −0.055 0.808 0.226 0.024 −0.073 0.475 TNFβ1*HBsAg −0.015 0.884 0.113 0.263 −0.105 0.300 −0.135 0.183 TNFβ3*HBsAg −0.089 0.459 −0.022 0.858 − − − − TNFβ2*HBsAg −0.110 0.359 0.023 0.850 − − − − Table S1. Correlation between cytokines and HBsAg dynamic changes in the PEG-IFN and ETV groups
Table 3 shows an analysis of the clinical characteristics of the PEG-IFN and ETV groups after 48 weeks of treatment. In the PEG-IFN group after 48 weeks of treatment, HBeAg serological disappearance occurred in 38 cases, and HBeAg seroconversion occurred in 25 cases; In the ETV group, HBeAg serological disappearance was found in 13 cases and HBeAg serological conversion in three cases. The serological disappearance rate and conversion rate between the two groups were statistically significantly different. (χ2 = 16.450; P < 0.001; χ2 = 12.324; P = 0.002). In the PEG-IFN group, HBsAg decreased ≥ 1 log10 in 23 cases, in which HBsAg disappeared in nine cases and HBs-Ab appeared in eight cases. In the ETV group, the decrease in HBsAg ≥ 1 log10 was found in seven cases, but no HBsAg disappeared. The decrease in HBsAg ≥ 1 log10 was statistically significantly different between the two groups (χ2 = 13.324; P < 0.001). There were 72 cases of complete virological response in the PEG-IFN group and 87 cases in the ETV group; this was not statistically significant between the two groups (χ2 = 12.430, P = 0.670). ALT normalization was achieved in 64 patients in the PEG-IFN group and in 90 patients in the ETV group; this was statistically significant between the two groups (χ2 = 17.850; P = 0.042).
Group PEG-IFN ETV χ2/P HBeAg disappearance (n, %) 38 (38%) 13 (13%) 16.450/< 0.001 HBsAg decline ≥ 1 log10 IU/mL (n, %) 23 (26.74%) 7 (7%) 13.324/< 0.001 Complete virological response (n, %) 72 (72%) 87 (87%) 12.430/0.670 ALT turn to normal (n, %) 64 (64%) 90 (90%) 17.850/0.042 Table 3. Comparison of clinical indicators between the PEG-IFN and ETV groups after 48 weeks of treatment
In conclusion, the levels of IFN-α2, IL-17A, and TNF-α in the PEG-IFN group were significantly higher than those in the ETV group after 3 months of antiviral therapy (P < 0.01); IL-10, IL-6, and TGF-β3 were significantly lower than those in the ETV group (P < 0.01). After 6 months of treatment, the levels of IFN-α2, IFN-γ and TNF-α in the PEG-IFN group were significantly higher than those in the ETV group (P < 0.01), while the levels of IL-6, IL-10, and TGF-β3 were significantly lower than those in the ETV group (P < 0.01). Compared with ETV treatment, the PEG-IFN group had a higher HBeAg disappearance rate, HBsAg response rate, and HBsAg disappearance rate.
Changes in the Cytokine Profiles of Patients with Chronic Hepatitis B during Antiviral Therapy
doi: 10.3967/bes2021.061
- Received Date: 2020-10-13
- Accepted Date: 2021-02-23
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Key words:
- Chronic hepatitis B /
- Cytokine /
- Interferon /
- Nucleoside (nucleotide) analog
Abstract:
Citation: | LI Ming Hui, LU Hui Hui, CHEN Qi Qi, LIN Yan Jie, ZENG Zhan, LU Yao, ZHANG Lu, DONG Jian Ping, YI Wei, XIE Yao. Changes in the Cytokine Profiles of Patients with Chronic Hepatitis B during Antiviral Therapy[J]. Biomedical and Environmental Sciences, 2021, 34(6): 443-453. doi: 10.3967/bes2021.061 |