拉米夫定治疗乙型肝炎病毒B、C基因型疗效比较

Effects comparison of lamivudine therapy for hepatitis B virus genotypes B and C

目的 研究乙型肝炎病毒(HBV)基因型对拉米夫定抗病毒疗效的影响。 方法 回顾调查235例拉米夫定治疗组和对照组患者的临床资料。 结果 135例患者接受拉米夫定抗病毒治疗,对照组100例。HBV优势基因型是B型和C型,拉米夫定治疗组有效率分别为92.9％和75.9％(x2=6.628,P<0.05),对照组有效率分别为9.8％和8.5％(P>0.05);YMDD变异发生率治疗组为3.6％和16.5％(x2=5.508.P<0.01)。结果发现,B基因型、丙氨酸氨基转移酶升高、HBV DNA低水平是抗病毒应答预测因素。 结论B基因氆HBV对拉米夫定的应答率优于C型,YMDD变异发生率低于C型,基因型是影响拉米夫定疗效和决定变异的重要因素之一。

Objective To determine the lamivudine response of HBV genotypes in patients with HBV DNA positive chronic hepatitis. Methods Clinical data from 235 patients in the original trial were analyzed. Result 135 patients received lamivudine and 100 patients as controls. Almost all patients had HBV genotypes B or C. Antiviral response were 92.9% and 75.9% in lamivudine-treated patients ( x2 = 6.628, P < 0.05) and 9.8% and 8.5% in untreated controls (P >.05) with HBV genotype B and C, respectively. The incidences of lamivudine-induced mutation in YMDD motif were 3.6% and 16.5% in HBV genotype B and C, respectively ( x2 = 5.508, P < 0.01). We identified HBV genotype B, elevated pretreatment alanine aminotransferase (ALT) levels, and low pretreatment HBV DNA levels as independent factors associated with antiviral response. Conclusion HBV genotype B was associated with a higher rate of lamivudine-induced HBV DNA clearance and lower rate of lamivudine-induced YMDD mutation compared with genotype C. HBV genotypes may be an important determinant of lamivudine therapy of chronic hepatitis B.