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

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 was 39.5% vs 25.6%（P〉0.05）.In genotype B and genotype C,ALT normalization rate after treatment for 12,24,48,96 weeks was 59.8% vs 47.0%,60.3% vs 63.6%,76.3% vs 77.3% and 80.0% vs 80.3%（P〉0.05）.Conclusion The genotype of HBV B and C could have the same virologic and biochemical response to adefovir dipiroxil therapy,suggesting that HBV genotypes are not obviously relevant to the virological response of adefovir dipiroxil treatment.The prevalence HBV genotype is genotype B and C,there ware no genotype A and D found in Jiangxi province.