HBeAg阳性B、C基因型乙肝患者使用拉米夫定治疗的病毒抑制效应对比分析

目的探讨拉米夫定对B、C基因型乙型肝炎（乙肝）患者治疗作用。方法观察未用、使用拉米夫定治疗的慢性乙肝患者随时间延长血清病毒标志物HBV DNA水平、HBeAg血清转换率及随拉米夫定疗程延长乙肝病毒聚合酶及转录酶区酪氨酸-蛋氨酸-门冬氨酸-门冬氨酸基序（HBV YMDD）耐药变异率等的变化,对比分析拉米夫定抗病毒治疗对B、C基因型乙肝患者的病毒抑制效应。结果（1）未用拉米夫定治疗的乙肝患者, B基因型者HBV DNA水平低于C基因型者,而自发HBeAg血清转换率高于C基因型者。（2）使用拉米夫定治疗的乙肝患者,B、C基因型者之间HBV DNA水平、HBeAg血清转换率及YMDD变异率没有明显差异。（3） B、C基因型患者均随拉米夫定疗程延长HBV DNA水平下降,HBeAg血清转换率增加,但YMDD变异率也增加。结论（1）未用拉米夫定治疗的自然状况下C基因型乙肝患者携带的乙肝病毒复制能力强于B基因型患者者且不易清除。（2）使用拉米夫定疗程相同时B、C基因型患者之间拉米夫定的病毒抑制效应及HBV YMDD耐药变异率相似。（3）C基因型HBV感染的乙肝患者及早使用拉米夫定抗病毒治疗意义更大。

Comparison of the effect of lamivudine inhibiting hepatitis B virus between genotype B and C chronic hepatitis B patients

Purpose To explore the effect of antiviral therapy with lamivudine for chronic hepatictis B patients with genotype B and C hepatitis B virus (HBV) infection,especial genotype C. Methods The effect of lamivudine inhibiting hepatitis B virus between chronic hepatictis B patients with genotype B and C HBV infection was compared by observing changes of genotype B and C HBV serum markers, such as HBV DNA level, HBeAg seroconversion rates and HBV YMDD mutations rates. Patients with genotype B and C HBV infection were treated with and without lamivudine respectivly with time extending. Results HBV DNA levels were higher, and spontaneous HBeAg seroconversion rates were lower in genotype C patients than genotype B in genotype B and C patients who were not treated with lamivudine. There were no significant differences in HBV DNA levels, HBeAg seroconversion rates and YMDD mutations rates between genotype B and C patients who treated with lamivudine. HBV DNA levels declined gradually, HBeAg seroconversion rates and YMDD mutations rates increased gradually in both genotype B and C patients with the course of treatment with lamivudine extending. Conclusions Genotype C HBV had higher activity and could not be cleared off more easily than genotype B HBV under spontaneous status that chronic hepatictis B patients were not treated with lamivudine. The effect of lamivudine inhibiting HBV was similar between genotype B and C patients in the same course of treatment using lamivudine. Atviral therapy with lamivudine had important significance and was essential for chronic hepatitis B patients with genotype C HBV infection.