HBeAg阳性慢性乙型肝炎患者HBV基因型分布及其与抗病毒治疗疗效的关系

Analysis on HBeAg positive chronic hepatitis B patients with HBV genotype distribution and its relationship with the efficiency of antiviral therapy

目的探讨绍兴地区拉米夫定治疗乙型肝炎病毒e抗原(HBeAg)阳性慢性乙型肝炎(CHB)患者乙型肝炎病毒(HBV)基因型的分布及其与抗病毒治疗疗效的关系。方法对122例HBeAg阳性CHB患者进行基因分型,分析接受拉米夫定抗病毒治疗1年后HBV基因型与HBVDNA、HBeAg、丙氨酸氨基转移酶(ALT)及HBVP基因变异的关系。结果122例CHB患者中,B基因型34例(27.87%),C基因型82例(67.21%),D基因型3例(2.45%),C/D混合基因型1例(0.82%),B/C混合基因型2例(1.64%)。B基因型感染者的HBVDNA转阴率、HBeAg转阴率显著高于C基因型感染者(P均<0.01),HBVDNA水平显著低于C基因型感染者(P<0.05),ALT复常率高于C基因型感染者,但差异无统计学意义(P>0.05)。B基因型感染者中临床表现以CHB轻度为主(44.12%),C基因型感染者临床表现以肝硬化失代偿期为主(30.49%)。B基因型感染者发生基因变异0例,C基因型感染者发生变异4例,两者差异无统计学意义(P>0.05)。结论绍兴地区HBeAg阳性CHB患者HBV以C基因型为主,感染B型HBV的患者较感染C型HBV的患者对抗病毒治疗的应答为好,且临床表现较轻。

Objective To investigate the distribution of hepatitis B virus （ HBV） genotype of hepatitis B e antigen （HBeAg） positive chronic hepatitis B （CHB） patients treated by lamivudine and its relationship with the efficiency of antiviral therapy .Methods A total of 122 HBeAg positive CHB patients were genotyped and received lamivudine treatment for 1 year, and the relationships of HBV genotype with HBV DNA , HBeAg, alanine aminotransferase （ ALT） and HBV P gene variation were analyzed .Results Among the 122 HBeAg positive CHB patients , there were 34 cases of B genotype （27.87%）, 82 cases of C genotype （67.21%）, 3 cases of D genotype （2.45%）, 1 case of C /D mixed genotype （0.82%） and 2 cases of B /C mixed genotype （1.64%）.The turning negative rates of HBV DNA and HBeAg in CHB patients with genotype B were higher significantly than those with genotype C （P〈0.01）, and the HBV DNA level was lower significantly than that with genotype C （P〈0.05）.The rate of normalization ALT was higher than that with genotype C, but had no statistical significance （P〉0.05）.Genotype B group were mainly patients with mild CHB （44.12 %）, while genotype C group were mainly patients with uncompensated liver cirrhosis （30.49%）. Genotype B infection group had no gene variation , there were 4 cases of variation in genotype C infection group , and there was no statistical significance（P〉0.05）.Conclusions HBV genotype C of HBeAg positive CHB patients is the major genotype in Shaoxing .HBV patients with geotype B infection have better response for antiviral therapy than those with genotype C infection , and the clinical manifestation is light .