抗病毒治疗慢性乙型肝炎患者血清HBsAg的下降特点及HBV基因型对其的影响  

Changes of serum HBsAg level under antiviral therapies and the possible impacts of HBV genotypes B and C:A pilot study

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

机构地区：[1]南方医科大学南方医院感染内科,广东省广州市510515

出　　处：《实用肝脏病杂志》2008年第3期145-149,共5页Journal of Practical Hepatology

基　　金：国家973基金资助项目(G1999054106)

摘　　要：目的了解血清HBsAg在抗病毒治疗时的下降特点及HBV基因型在其中的作用。方法对在广州南方医院接受抗病毒治疗的80例(阿德福韦组47例、派罗欣组33例)慢性乙型肝炎患者系列血清进行HBsAg定量检测,PCR-RFLP方法进行HBV基因型检测;将基因A至D型的HBV复制质粒转染入Huh7细胞,添加干扰素-α2a并检测细胞内外HBsAg水平变化。结果阿德福韦或派罗欣均可降低血清HBsAg;12周时分别降至基线水平的59.8%和53.6%;治疗12至24周期间HBsAg下降不明显,下降速度仅为前12周的11.2%和9.2%。阿德福韦组HBV基因B型(n=20)和C型(n=24)患者的12周血清HBsAg下降无区别(分别为基线的39.4%和61.6%,P=0.092);派罗欣组HBV基因B型(n=16)和C型(n=12)患者的12周HBsAg下降至32.6%和54.7%(P=0.174)。细胞内或细胞培养上清HBsAg下降在基因A至D型间无区别。结论阿德福韦和派罗欣治疗都可以降低血清HBsAg水平;下降主要发生在治疗的前12周,下降速度和HBV基因型(B/C)无关。Objectives To observe the changes of serum HBsAg under antiviral therapies in chronic hepatitis B patients,and the influences of HBV genotypes B/C on the changes. Methods 47 patients treated with adefovir and 33 with peg-interferon-α2a were studied. Abbott Architect HBsAg assay was used to quantify serum HBsAg in serial samples collected at baseline,treatment week 12,24 and 48. Direct sequencing of PCR fragments covered HBV nt1650-nt2065 was adopted to determine genotypes of hepatitis B virus. Plasmids contained 1.24 unit HBV genome （genotype Ae,Ba,C and D）were transfected into Huh7 cells and interferon-α2a （1500Iu/ml）was then added to culture medium,supernatants and cell lysates were collected after 72 hours and HBsAg quantification was performed. Results Both adefovir and peg-interferon-α2a reduced serum HBsAg levels at treatment week 12 to 59.8% and 53.6% compared to baseline （P=0.005 and 0.001 ,respectively）. Reductions of HBsAg from treatment week 12 to 24 were not significant in both adefovir and peg-interferon-α2a groups（P=0.055 and 0.067,respectively）,and the median change values of HBsAg from week 12 to 24 were just 11.2% and 9.2% of these counterpart values from baseline to week 12. In adefovir treatment groups,HBsAg was reduced to 39.4% in genotype B and 61.6% in genotype C patients during first 12 treatment weeks（P=0.092）;in peg-interferon-α2a group,HBsAg was reduced to 32.6% for genotype B and 54.7% for type C,and was not different either （P= 0.174）. Comparing to interferon blank plates,HBsAg in the superuatants was reduced to 36.9% or lower,and no difference was found among these four genotypes （P=0.223）;intracellular HBsAg was also reduced to at least 60.5%,and there was no difference found either（P=0.877）. Conclusions Both adefovir and peg-interferon-α2a can decrease serum HBsAg levels,and the reductions in the first 12 treatment weeks were predominant. But the reductions has no association with HBV genotypes B/C.

关 键 词：慢性乙型肝炎 表面抗原 阿德福韦 聚乙二醇干扰素-α2a 基因型 

分 类 号：R512.62[医药卫生—内科学]