乙型肝炎病毒基因型与拉米夫定治疗疗效关系的研究

Relationship between the genotypes of hepatitis B virus and the response to lamivudine therapy

目的探讨乙型肝炎病毒(HBV)基因型与拉米夫定治疗疗效的关系及其机理。方法对拉米夫定治疗的228例慢性乙型肝炎患者的临床资料进行收集和整理,分析HBV基因型与拉米夫定治疗疗效的关系;并对各HBV基因型影响拉米夫定疗效的可能因素进行探讨。结果HBV基因型B型对拉米夫定治疗的应答率为40.6%,C基因型的应答率为21.2%,两组应答率差异有显著性(P<0.05);B基因型的HBeAg的血清转换率为26.3%,C基因型为12.4%,统计学方法处理有显著性差异(P<0.05)。拉米夫定治疗期间的YMDD变异发生率B基因型组为13.2%,C基因型组为37.4%,两组差异有显著性统计学意义(P<0.05)。结论拉米夫定治疗慢性乙型肝炎患者,HBVB基因型的疗效优于C基因型,其疗效机理可能与拉米夫定治疗后C基因型容易发生YMDD变异有关。

Objective To study the relationship between the genotypes of hepatitis B virus and the response to lamivudine therapy and its mechanisms. Methods The clinical data of 228 patients with chronic hepatitis B (CHB) treated with lamivudine in Shenzhen people′ hospital were collected. The relationship between the genotypes of hepatitis B virus and the response to lamivudine therapy was analyzed. The predictive factors associated with antiviral response among patients treated with lamivudine was studied. Results The rate of antiviral response to lamivudine therapy in patients with genotype B virus infection and genotype C virus infection was 40.6% and 21.2%, respectively. There was significant difference between the two groups (P<0.05). The seroconversion rate of serum HBeAg in patients with genotype B virus infection was significantly higher than those with genotype C infection (26.3% vs 12.4%, P<0.05). Incidence of YMDD motif mutation during lamivudine therapy in patients with genotype B virus was lower than the patients with genotype C(13.2% vs 37.4%, P<0.05). Conclusion The rate of antiviral response to lamivudine therapy in patients with HBV genotype B infection was higher than those with HBV genotype C infection. The higher percentage of YMDD motif mutation in genotype C virus may be responsible for the poorer response to lamivudine therapy in CHB patients.