慢性乙型肝炎患者抗病毒治疗耐药相关性研究

目的 探讨甘肃省慢性乙型肝炎(CHB)患者基因型的分布,以及阿德福韦酯(ADV)等核苷类似物(NAs)治疗中耐药与HBV基因型、用药方式的关系.方法 兰州大学第一医院自2009年1月至2011年1月收治的87例CHB患者,根据是否应用核苷类似物治疗分为治疗组(n=75)和对照组(n=12).检测并比较两组患者的HBsAg、肝功能、HBV DNA和HBV基因型及耐药位点.结果 入组CHB患者中基因C型72例(82.76％),B型9例(10 34％),D型5例(5 75％),F型1例(1.15％).其中治疗组48例出现耐药,耐药率64.00％,对照组3例耐药,耐药率25.00％,差异具有统计学意义(x2=6.487,P＜0.05).治疗组中,ADV单药治疗18例,耐药率为61.11％,序贯或联合治疗24例,耐药率66.67％,耐药率之间差异无统计学意义(x2 =0.138,P＞ 0.05); ADV治疗的CHB病例中基因C型34例,耐药率70.59％,B型5例,耐药率60.00％,不同基因型的耐药率差异无统计学意义(P＞0.05).结论 甘肃地区HBV基因以C型为主,而ADV治疗后不同基因型对耐药影响不大,用药方式对耐药率也无明显影响.

Drug resistance-related research during antiviral therapy in patients with chronic hepatitis B

Objective To investigate HBV genotype in chronic hepatitis B （CHB） patients in Gansu province and analyze the relations between the drug resistance treated with analogues （NAs）such as adefovir dipivoxil （ADV） and HBV genotype, drug regimen. Methods Eighty-seven CHB patients were selected in the First Hospital of Lanzhou Uni- versity from January 2009 to January 2011. According to the application of NAs therapy, patients were divided into treated group and control group. There were 75 patients in treated group, and 12 patients in untreated group（ control group）. HBsAg, liver function, HBV DNA, HBV genotypes and drug resistance points of both two group patients were detected. Results In all CHB patients, there were 72 cases （82.76%） with genotype C, 9 cases （10.34%） with genotype B, 5 cases （5.75%） with genotype D,1 case（l.15%） with genotype F. There were 48 cases with drug resistance in treated group, the rate of drug resistance was 64.00% ; while 3 cases occurred drug resistance in control group, whose drug resistant rate was 25.00%. There were statistical differences between two groups （χ2 = 6.487, P 〈 0.05）. 18 cases used with ADV single-agent therapy in the treated group, the resistance rate of them was 61.11%. 24 cases used with ADV sequential or combined treatment in the treated group, the resistance rate of them was 66.67%. There was no difference between the different medication way （χ2 = 0. 138, P 〉 0.05）. In the ADV treatment group, 34 cases were genotype C, whose drug resistance rate was 70.59% ; 5 cases were genotype B, whose drug resistance rate was 60%. There were no differences between the different genotypes （ P 〉 0.05）. Conclusions The main HBV genotype in Gansu region is genotype C. ADV treatment of different genotypes of CHB patients may have small impaction on the drug resistance, as well as the medication way.