替诺福韦治疗不同HBV基因型慢性乙型肝炎患者疗效研究  

Response to tenofovir antiviral therapy different in patients with chronic hepatitis B and different HBV genotype infection?

作　　者：刘雨莹 张娇珍 周海娟 潘芳蝶 黎才丽 钟昌宝 Liu Yuying;Zhang Jiaozhen;Zhou Haijuan(Clinical Laboratory,Traditional Chinese Medicine Hospital,Haikou 570216,Hainan Province,China)

机构地区：[1]海口市中医医院检验科,571103 [2]海口市中医医院脾胃肿瘤科,571103 [3]海南医学院第二附属医院检验科

出　　处：《实用肝脏病杂志》2022年第4期492-495,共4页Journal of Practical Hepatology

基　　金：海南省自然科学基金面上项目(编号:821MS158)。

摘　　要：目的探讨替诺福韦治疗不同HBV基因型感染的慢性乙型肝炎(CHB)患者的疗效和血清金属硫蛋白(MT)、白细胞介素29(IL-29)和外周血淋巴细胞程序性死亡受体-1(PD-1)表达的变化。方法2017年1月~2020年11月我院诊治的CHB患者119例,均接受替诺福韦治疗。采用ELISA法检测血清MT和IL-29水平,使用流式细胞仪检测外周血T淋巴细胞PD-1表达水平。结果在本组119例CHB患者中,检出HBV B基因型31例(26.1%),C基因型77例(64.7%),B/C混合基因型11例(9.2%);基线资料比较,B基因型CHB患者血清ALT和AST水平分别为(154.1±46.7)U/L和(83.3±26.8)U/L,显著高于C基因型患者【分别为(135.8±40.3)U/L和(68.5±20.6)U/L,P<0.05】或B/C混合基因型患者【分别为(138.9±50.2)U/L和(71.6±23.9)U/L,P<0.05】,而血清HBV DNA水平为(6.7±1.1)lg copies/ml,显著低于C基因型感染患者【(7.8±1.4)lg copies/ml,P<0.05】或B/C混合型感染者【(7.4±1.0)lg copies/ml,P<0.05】;在治疗24 w和48 w末,三组血清ALT复常率无显著性差异(P>0.05),而B基因型和C基因型感染患者血清HBV DNA阴转率分别为96.8%和96.8%,和88.3%和93.5%,均显著高于B/C混合型感染患者(分别为63.6%和81.8%,P<0.05);在治疗48 w,B基因型CHB患者血清MT水平显著高于C基因型或B/C基因型(P<0.05),血清IL-29水平显著高于C基因型(P<0.05),而外周血CD4^(+)和CD8^(+)T淋巴细胞表面PD-1表达水平显著低于C基因型或B/C混合基因型患者(P<0.05)。结论不同HBV基因型感染的CHB患者可能对替诺福韦治疗的疗效存在差异,深入了解这些差异可能对研究不同基因型病毒感染患者临床转归有帮助。Objective The aim of this study was to investigate the response to tenofovir antiviral therapy in chronic hepatitis B(CHB)patients with different HBV genotype infection.Methods A total of 119 patients with CHB were enrolled in our hospital between January 2017 and November 2020,and all received tenofovir therapy.The HBV genotypes were detected.Serum metallothionein(MT)and interleukin-29(IL-29)levels were assayed by ELISA.The programmed cell death-1(PD-1)expression on peripheral blood lymphocytes was detected by FCM.Results Out of the 119 patients with CHB,the HBV genotype B infection was found in 31 cases(26.1%),genotype C infection was found in 77 cases(64.7%)and genotype B/C mixed infection in 11 patients(9.2%);at baseline,serum ALT and AST levels in CHB patients with genotype B infection were(154.1±46.7)U/L and(83.3±26.8)U/L,significantly higher than[(135.8±40.3)U/L and(68.5±20.6)U/L,P<0.05]in patients with C infection or[(138.9±50.2)U/L and(71.6±23.9)U/L,P<0.05]in B/C mixed infection,while serum HBV DNA load was(6.7±1.1)lg copies/ml,significantly lower than[(7.8±1.4)lg copies/ml,P<0.05]in C or[(7.4±1.0)lg copies/ml,P<0.05]in B/C infection;at the end of 24 week and 48 week treatment,there were no significant differences as respect to serum ALT normalization rates in the three groups(P>0.05),while serum HBV DNA loss in patients with B and C infection were 96.8%and 96.8%,and 88.3%and 93.5%,all significantly higher than 63.6%and 81.8%(P<0.05)in patients with B/C mixed infection;at the end of 48 week treatment,serum MT level in patients with B infection was significantly higher than in patients with C or B/C infection(P<0.05),serum IL-29 level was significantly higher than in patients with C infection(P<0.05),while the PD-1 expression on peripheral blood CD4^(+)and CD8^(+)T cell surfaces was significantly lower than in patients with C or B/C infection(P<0.05).Conclusion The antiviral response to tenofovir treatment in CHB patients with different HBV genotype infection could be different,and further invest

关 键 词：慢性乙型肝炎 HBV基因型 替诺福韦 治疗 

分 类 号：R512.62[医药卫生—内科学]