慢性乙型肝炎基因分型与阿德福韦酯疗效相关性研究  

Correlativity study on relationship between efficacy of adefovir dipvoxil and HBV genotypes in chronic hepatitis B

作　　者：程欣[1] 徐龙[1] 张骏[1] 任贵英[2] 徐贞秋[1] 龙涛[1] 洪建明[1] 朱龙川[1] 付军[1] 熊晓晴[1] 

机构地区：[1]南昌市第九医院传染科,江西南昌330002 [2]上海市复旦大学附属公共卫生临床中心重症肝病科,上海201508

出　　处：《临床荟萃》2010年第20期1758-1760,共3页Clinical Focus

基　　金：江西省科技厅支撑计划项目资助(2007BS0520)

摘　　要：目的调查本地区乙型肝炎病毒(HBV)基因分型的分布情况,观察乙型肝炎基因分型对阿德福韦酯抗病毒疗效的影响。方法对285例慢性乙型肝炎(其中HBV基因型B型219例,C型66例)用阿德福韦酯治疗的慢性乙型肝炎的患者进行分析,观察治疗12周、24周、48周及96周丙氨酸转氨酶(ALT)、HBV DNA定量、乙型肝炎病毒e抗原(HBeAg)乙型肝炎病毒e抗体定量。结果阿德福韦酯治疗12周时B组以及C组HBV DNA转阴率为30.6%及36.4%,HBV DNA下降均值为(1.36±0.98)copies/ml及(1.31±1.40)copies/ml(P>0.05);治疗24周两组HBV DNA转阴率分别为33.8%及42.4%,HBV DNA下降均值为(2.19±1.18)copies/ml及(2.22±1.10)copies/ml(P>0.05)。治疗48周两组HBV DNA转阴率分别为38.8%及45.5%,HBV DNA下降均值为(2.98±1.24)copies/ml及(2.97±0.92)copies/ml(P>0.05)。治疗96周两组HBV DNA转阴率分别为44.8%及48.5%,HBV DNA下降均值为(3.41±1.68)copies/ml及(3.50±1.72)copies/ml(P>0.05)。治疗12周后B、C两组HBeAg转阴HBeAb出现分别为10.6%vs 8.6%及11.6%vs 9.3%,24周后B、C两组HBeAg转阴/HBeAb出现分别为14.6%vs 11.3%及16.3%vs 11.6%,48周后B、C两组HBeAg转阴/HBeAb出现分别为27.8%vs 21.2%及25.6%vs 20.9%,96周后B、C两组HBeAg转阴/HBeAb出现分别为36.4%vs 25.2%及39.5%vs 25.6%,两组差异均无统计学意义(P>0.05)。两组ALT复常率12周为59.8%vs 47.0%(P<0.05),24周为60.3%vs 63.6%,48周为76.3%vs 77.3%,96周为80.0%vs 80.3%,两组差异均无统计学意义(P>0.05)。结论阿德福韦酯治疗慢性乙型肝炎B型及C型,病毒应答、生化应答及血清学应答相当,阿德福韦酯对HBV基因B型及C型疗效无明显影响。本地区HBV基因型以B型为主,C型次之,未发现A、D型。Objective To investigate the distribution of hepatitis B virus（HBV） genotypes and observe the response of different HBV genotypes to adefovir dipiroxil in antiviral treatment of chronic hepatitis B.Methods The alanine aminotransferase（ALT） level,HBV DNA quantum and HBV-M quantum of 285 cases with chronic hepatitis B（219 cases of genotype B named group B and 66 cases of genotype C named group C） were observed in 12,24,48 and 96 weeks after treatment with adefovir dipiroxil.Results After 12 weeks of adefovir dipivoxil therapy,HBV DNA negative conversion rate of genotype B and genotype C was 30.6%,36.4%,respectively.The mean HBV DNA reduction in patients with genotype B and genotype C was （1.36±0.98） copies/ml,（1.31±1.40） copies/ml（P〉0.05）.After treatment for 24 weeks,HBV DNA negative conversion rate of genotype B and genotype C was 33.8% and 42.4%.The mean HBV DNA reduction in patients with genotype B and genotype C was（2.19±1.18） copies/ml,（2.22±1.10） copies/ml（P〉0.05）.After 48 weeks of therapy,two genotypes＇ HBV DNA negative conversion rates were 38.8% and 45.5%.The mean HBV DNA reduction in patients with genotype B and genotype C was（2.98±1.24） copies/ml,（2.97±0.92） copies/ml（P〉0.05）.After 96 weeks of therapy,HBV DNA negative conversion rate of two genotypes was 44.8% and 48.5%.The mean HBV DNA reduction in patients with genotype B and genotype C was（3.41±1.68） copies/ml,（3.50±1.72） copies/ml（P〉0.05）.After 12 weeks＇ therapy,the HBeAg negative conversion rate of genotype B and genotype C was 10.6% vs 8.6%,while HBeAb occurrence was 11.6% vs 9.3%.After 24 weeks of therapy,HBeAg negative conversion rate of two genotypes was 14.6% vs 11.3%,while the HBeAb occurrence was 16.3% vs 11.6%.After 48 weeks of therapy,HBeAg negative conversion rate of two genotypes was 27.8% vs 21.2%,while HBeAb occurrence was 25.6% vs 20.9%.After 96 weeks of therapy,HBeAg negative conversion rate of two genotypes was 36.4% vs 25.2%,while the HBeAb occurrence wa

关 键 词：肝炎 乙型 肝炎病毒 乙型 基因型 丙氨酸转氨酶 阿德福韦酯 

分 类 号：R512.62[医药卫生—内科学]