乙型肝炎病毒基因型与聚乙二醇干扰素α治疗HBeAg阳性慢性乙型肝炎疗效的关系

Study on the relationship between hepatitis B virus genotypes and the effect of polyethylene glycol- interferon-alpha therapy on HBeAg-positive chronic hepatitis

目的探讨本地区乙型肝炎病毒（HBV）基因型与聚乙二醇干扰素Q（PEG—IFNct）治疗HBVe抗原（HBeAg）阳性慢性乙型肝炎（CHB）疗效的关系。方法199例基因型明确的HBeAg阳性CHB患者经皮下注射PEG—IFNot-2a或PEG．IFNct-2b治疗，每周1次，疗程为48周，停药后随访24周。统计治疗早期（3个月）和疗程结束并随访6个月的HBeAg血清学转换情况，分析HBV基因型对HBeAg血清学转换的影响。结果本地区CHB患者以HBV基因C型[64．32％（128／199）]病毒感染为主。除丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）外，基因B、C型感染患者的性别、年龄、肝细胞炎症活动度和纤维化程度、HBeAg、HBVDNA水平等的差异均无统计学意义（P值均〉0．05）。基因B型感染患者治疗早期（3个月）HBeAg血清学转换率显著高于C型感染患者[26．76％（19／71）比10．16％（13／128），z。=9．330，P=0．002]。至疗程结束并随访6个月时，基因B型患者HBeAg血清学转换率虽仍稍高于C型[39．44％（28／71）比30．47％（39／128）]，但其差异无统计学意义（r=1．645，P=0．200）。单因素时序检验显示，基因B型感染患者HBeAg血清学转换出现较C型感染患者早[（13．99±0．67）个月比（15．47±0．41）个月]，但差异无统计学意义（P=0．150）。结论基因B型HBeAg阳性CHB患者在PEG．IFNct治疗的早期（3个月）HBeAg血清学转换率显著高于C型，但它们的长期转换率差异不大。

Objective To investigate the efficacy of polyethylene glycol （PEG）-interferon a （PEG-IFNot） in treating HBeAg-positive chronic hepatitis B （CHB） and explore the relationship between hepatitis B virus （HBV） genotypes and the effect of interferon c~ （IFNct） therapy. Methods A total of 199 CHB patients with known genotypes were given subcutaneous injection of PEG-IFNo^-2a or PEG-IFNot-2b once a week for 48 weeks, with another 24 weeks follow up. The seroconversion of HBeAg influenced by HBV genotypes were analyzed after discontinuation of treatment. Results In local area, genotype C was the major genotype[64. 32% （128/199） ]. Except serum ALT and AST level, the differences in gender, age, liver inflammation, degree of liver fibrosis, HBeAg level and HBV DNA level between genotype B and C were not statistically significant （all P 〉 0. 05 ）. The seroconversion rate of HBeAg in patients with genotype B at early stage of therapy （ 3 months） was significantly higher than that of patients with genotype C [ 26. 76% （ 19/71 ） vs 10. 16% （13/128）, X2 = 9. 330, P = 0. 002]. While at the end of follow-up, seroconversion rate of HBeAg in patients with genotype B （ followed up for 6 months） was higher than that of patients with genotype C[39.44% （28/71） vs 30. 47% （39/128） ], but the difference was not statistically significant（x2 = 1. 645, P = 0. 200）. By univariate analysis based on log-rank test, the time of HBeAg seroconversion in patients with genotype B was much earlier than that of genotype C [ （ 13.99 ＋ O. 67 ） months vs （ 15.47 ~ 0. 41 ） months ], but the difference was not statistically significant（ P = 0. 150）. Conclusions The seroconversion rate of HBeAg in patients with genotype B treated with PEG-IFNct was significantly higher than that of genotype C in early stage of therapy （3 months）, while similar at the end of therapy.