Objective To investigate the clinical effect of pegylated interferon α-2 a ( PEG-IFNα-2 a) in the treatment of previously untreated HBeAg-positive chronic hepatitis B ( CHB) patients and related predictive factors. Methods A retrospective analysis was performed for 111 previously untreated HBeAg-positive CHB patients who were treated with PEG-IFNα-2 a in Department of Hepatology in the Second Affiliated Hospital of Anhui Medical University from January 2011 to June 2015. The patients were followed up for serum HBs Ag quantitation, HBeAg quantitation, HBV DNA quantitation, and alanine aminotransferase ( ALT) level at baseline and at weeks 12, 24, and48 of treatment. At week 48 of treatment, of all 111 patients, 35 achieved HBeAg seroconversion ( 48-week seroconversion group) and 76 did not achieve such seroconversion ( 48-week non-seroconversion group) . The independent samples t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. The receiver operating characteristic ( ROC) curve was used to evaluate the efficiency of related indices in predicting treatment outcomes, and the area under the ROC curve ( AUC) was compared to evaluate the predictive value of each index. The dichotomous logistic regression model was used to evaluate the influence of independent variables on HBeAg seroconversion. Results There was a significant difference in HBeAg level between the two groups before treatment ( t =-3. 361, P < 0. 05) . At week 12 of treatment, there were significant differences between the two groups in HBs Ag quantitation ( t =-3. 225, P < 0. 05) , reduction in HBs Ag ( Z =-2. 202, P < 0. 05) , HBeAg quantitation ( Z =-5. 025, P < 0. 05) , reduction in HBeAg ( Z =-3. 569, P < 0. 05) , HBV DNA quantitation ( Z =-3. 261, P < 0. 05) , and reduction in HBV DNA ( t = 2. 202, P < 0. 05) .At week 24 of treatment, there were significant differences between the two groups in HBs Ag quantitation ( t =-3. 222, P < 0. 05) , reduction in HBs Ag ( Z =-1. 860, P < 0. 05) , HBeAg quantitation ( Z =-5. 951, P < 0. 05) , reduction in HBeAg ( t = 5. 514, P < 0. 05) , HBV DNA quantitation ( Z =-2. 311, P < 0. 05) , and ALT level ( Z =-2. 234, P < 0. 05) . HBeAg quantitation at week 24 had a high predictive value ( AUC = 0. 88, P < 0. 001) , with a sensitivity of 94. 03%, a specificity of 64. 52%, a positive predictive value of85. 10%, and a negative predictive value of 83. 30% at a cut-off value of 0. 18 log10 S/CO. In addition, HBeAg quantitation at week 12 and reduction in HBeAg at week 24 had a good predictive value ( AUC = 0. 81 and 0. 80, respectively) . Baseline HBeAg < 2. 91 log10 S/CO ( odds ratio [OR]= 10. 086, 95% confidence interval [CI]: 1. 64-61. 93, P = 0. 013) , ALT < 1. 45 × upper limit of normal ( ULN) at week 24 ( OR = 5. 228, 95% CI: 1. 27-21. 45, P = 0. 022) , and reduction in HBeAg > 1. 5 log10 S/CO at week 24 ( OR = 5. 780, 95%CI: 1. 38-24. 25, P = 0. 016) were independent predictive factors for HBeAg seroconversion at week 48. Conclusion Baseline HBeAg level, HBs Ag/HBeAg/HBV DNA levels and reductions at week 12 of treatment, HBs Ag/HBeAg levels and reductions at week 24 of treatment, and HBV DNA and ALT levels at the same time points have a certain value in predicting HBeAg seroconversion at week 48.
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