慢性肝炎病毒C基因启动子(BCP)变异与干扰素应答的关系

Relationship between the mutations in the core promotor and the response to interferon treatment in chronic hepatitis

为了探讨干扰素治疗慢性乙型肝炎的疗效与慢性乙型肝炎病毒C区启动子 (BCP)变异之间的关系 ,对 89例HBVDNA阳性的慢性乙型肝炎患者 ,应用错配PCR -RFLP分析技术结合直接序列分析 ,共检出 47例BCP变异株 ,其中 2 4例曾应用干扰素治疗 ,野生株 2 1/4 2例应用干扰素治疗。 2 4例HBVC区启动子变异株对干扰素治疗有效 12例 ;野生株 2 1例 ,对干扰素有效 18例 ,二组相比差异有显著性。野生株组的ALT复常 ,HBVDNA阴转率高于变异株组 (p <0 .0 5 )。而治疗组中变异株组的野生株转化率为 38 9%明显高于对照组 (5 0 % ) ,差异显著 (p <0 .0 5 )。混合感染的病例 ,干扰素治疗后有变异株去优势化积累趋势。提示干扰素治疗不会诱发BCP变异的发生 ,但有BCP变异的病例可降低干扰素的疗效 ,同时也说明变异株对干扰素治疗有反应 。

In order to evaluate the response to interferon in chronic hepatitis B patients with HBV C promotor mutants,HBV core promotor genic fragments were amplified by using mismatched PCRcombined with direct sequencing.There were 47(52.8%) cases with mutations in BCP region,in which 24 cases were treated with interferon,in 89 patients with CHB,and 12 cases(50%)have responses to interferon in observed group.21 cases were treated with interferon in 42 cases with wild type strain infection,of which 18(85.7%)have responses to interferon.There was statistic difference between the two groups.The rate of ALT renormal and HBVDNA negative in the wild type group was significant higher than in the mutant group( p <0.05).The rate from mutant-type return to the wild type in treatment group(38.9%) was higher than in control group( p <0.05).The prevalent accumulaion of mutation in coinfectiontype might been eliminated after interferon treatment.These results suggest that the BCP mutation is not induced by interferon treatment,but it might reduce the effect of interferon.It may be sensitive actually that the mutant type have response to the interferon therapy,only might it need longer time with big dosage of interferon to clear the virus.