内江地区慢性乙型肝炎患者的基因型及拉米夫定联合阿德福韦酯抗病毒治疗效果

Clinical efficacy of combination of initial lamivudine and adefovir dipivoxil in treatment of HBeAg(+)genotype B/C patients with chronic hepatitis B

目的探讨内江地区慢性乙型肝炎患者的基因型及拉米夫定联合阿德福韦酯抗病毒的治疗效果。方法将201例慢性乙型肝炎患者进行HBV基因型的测定,其中120例HBeAg(+)慢性乙型肝炎患者随机分为三组:A组、B组和C组,每组40例。A组给予拉米夫定(LAM)治疗;B组给予恩替卡韦(ETV)治疗;C组给予LAM联合阿德福韦酯(ADV)治疗,比较治疗情况。结果 201例慢性乙型肝炎患者中B型119例(59.2%),C型68例(33.8%),B/C混合型10例(5.0%),未知型4例(2.0%),各分型之间的性别、年龄差异无统计学意义(P>0.05)。C型感染者HBeAg阳性率为86.8%,显著高于B型的51.3%(P<0.05)。HBeAg(+)的3组患者治疗12、24和48周时,B组和C组患者的ALT复常率、HBV DNA阴转率及48周时的HBeAg血清转换率均显著高于A组(P<0.05);C组患者与B组比较差异无统计学意义(P>0.05)。治疗期间均未见不良反应发生。C组患者(包括B型19例、C型21例)中B型的HBV DNA阴转率及HBeAg血清转换率显著高于C型(P<0.05)。结论地处西南方的内江地区慢性乙型肝炎患者主要以B型为主,C型次之,B型和C型共占93.0%,其他型别仅占较少部分。ETV方案或LAM联合ADV方案治疗HBeAg(+)慢性乙肝疗效优于LAM治疗。初始LAM联合ADV治疗基因B型HBeAg(+)慢性乙型肝炎疗效优于C型。

Objective To investigate the genotype of patients with chronic hepatitis B in Neijiang area and the antiviral effect of lamivudine（LAM）combined with adefovir dipivoxil（ADV）.Methods 201 patients with chronic hepatitis B were detected for HBV genotype.Among them,the 120 patients with HBeAg（＋）chronic hepatitis B were randomly divided into group A,group B or group C,with 40 patients in each group.Group A received LAM treatment;Group B was given entecavir（ETV）treatment;Group C was given LAM combined with ADV treatment.The effects of treatment were compared.Results Among the 201 patients with chronic hepatitis B,there were 119cases（59.2%）of genotype B,68cases（33.8%）of genotype C,10 cases（5.0%）of mixed genotype B/C,and 4 cases of unknown genotype（2.0%）.There were no significant differences in sex and age among the genotypes（P〈0.05）.The rate of positive HBeAg in genotype C group was 86.8%,significantly higher than that in genotype B group（51.3%）（P〈0.05）.The ALT normalization rates,negative conversion rates of HBV DNA and HBeAg seroconversion rates of HBeAg（＋）patients in group B and group C were significantly higher than those in group A（P〈0.05）at Week 12,24 and 48 after treatment（P〈0.05）;There was no significant difference between group C and group B（P〈0.05）.No adverse events occurred during treatment.In group C,the conversion rates of HBV DNA and HBeAg of genotype B patients were significantly higher than those of genotype C patients（P〈0.05）.Conclusion The main genotype of HBV in Neijiang area is B,followed by genotype C;both of genotypes B and C accounted for 93.0%.ETV regimen or LAM combined with ADV regimen for treatment of HBeAg（＋）chronic hepatitis B is superior to LAM treatment.The efficacy of initial LAM combined with ADV for treatment of genotype B HBeAg（＋）chronic hepatitis B is better than for genotype C.