乙型肝炎病毒基因型对拉米夫定治疗早期血清乙型肝炎表面抗原水平变化的影响  

Changes of serum hepatitis B surface antigen level in HBeAg positive chronic hepatitis B patients at the twelth week of lamivudine treatment:relations to hepatitis B virus genotypes

作　　者：陈金军[1] 王战会[1] 马世武[1] 陈永鹏[1] 彭劼[1] 郭亚兵[1] 侯金林[1] 

机构地区：[1]南方医科大学南方医院感染内科肝病中心,广州510515

出　　处：《肝脏》2008年第2期101-103,共3页Chinese Hepatology

基　　金：国家973课题(2005CB523104)

摘　　要：目的了解血清乙型肝炎表面抗原(HBsAg)水平在拉米夫定治疗早期的变化特点及乙型肝炎病毒(HBV)基因型在其中的作用。方法乙型肝炎e抗原(HBeAg)阳性且拉米夫定为初始抗病毒治疗的慢性乙型肝炎患者87例,雅培HBsAg Architect方法定量检测治疗基线和第12周血清HBsAg水平;采用聚合酶链反应联合限制性片段长度多态性分析的方法确定HBV基因型。结果所有患者治疗第12周血清HBV DNA水平下降(中位数4.31log10拷贝/ml,P<0.001)。总的血清HBsAg下降至基线的57.99%(P<0.001),但主要发生在HBV基因B型患者(43例,P<0.001),在HBV基因C型患者变化不明显(43例,P=0.378)。血清HBsAg和HBV DNA变化(基线和12周)之间的正相关关系仅存在于基因B型(Rs=0.577,P<0.001),而在C型患者中不明显(Rs=0.068,P=0.686)。基线HBsAg水平低(比数比值为0.387,95%可信区间为0.188～0.794,P=0.010)和HBV基因C型感染(比数比值为4.083,95%可信区间为1.362～12.236,P=0.012)是导致32.2%(29例)患者血清HBsAg水平未下降的主要因素。结论在拉米夫定治疗HBeAg阳性慢性乙型肝炎的早期,超过30%的患者血清HBsAg水平并没有随着HBV DNA复制水平下降而下降,HBV基因C型感染和基线HBsAg水平低是其主要因素。Objective To investigate the characteristics of serum hepatitis B surface antigen （HBsAg） changes, and on which the possible influences of Hepatitis B virus （HBV） genotypes have, at initial stage of lamivudine treatment in hepatitis B e antigen（HBeAg） positive chronic hepatitis B patients. Methods 87 patients who were HBeAg positive and naive to antiviral therapy prior to lamivudine treatment were studied. Abbott Architect HBsAg assay was used for quantification of serum HBsAg levels at treatment baseline and week 12. HBV genotypes were determined with polymerase chain reaction combined with restriction fragment length polymorphism. Results Serum HBV DNA levels in all patients were decreased from baseline to week 12 with a range of 0.75-7.80 （log10 copies/ml, median value was 4.31, P〈 0.001 ）, and collectively serum HBsAg was reduced to 57.99% taken baseline as 1.0 （P〈0. 001 ）. However conspicuouse serum HBsAg reductions were only found in patients with HBV genotype B （HBV/B, n = 43, P〈0. 001 ） but not in genotype C （HBV/C, n = 43, P = 0. 378）. Positive correlation was found between changes of serum HBsAg from baseline to week 12 and those of serum HBV DNA （Rs = 0. 341, P = 0.002, n = 87）, which seemed ＇stronger＇ （Rs = 0. 577, P〈0. 001） in HBV/B patients but ＇disappeared＇ （Rs = 0. 068, P = 0. 686） in HBV/C patients. Along with HBV DNA levels decreasing from treatment baseline to week 12, reductions of serum HBsAg was not achieved in 32.2% （n = 29） patients, which were determined by low levels of serum HBsAg at baseline （odds ratio was 0. 387 and 95 % confidence interval was 0. 188-0. 794, P = 0. 010） and infection with HBV/C （odds ratio was 4. 083 and 950/00 confidence interval was 1. 362- 12.236, P=0.012）. Conclusion Serum HBsAg in some patients was not decreased along with HBV DNA under 12 weeks lamivudine treatment, on which HBV/C infection and low levels of baseline serum HBsAg had determinant affects.

关 键 词：慢性乙型肝炎 乙型肝炎表面抗原 拉米夫定 基因型 

分 类 号：R512.62[医药卫生—内科学] R373.21[医药卫生—临床医学]