慢性乙型肝炎患者口服抗病毒药物治疗的病毒学突破与耐药情况分析

目的:探讨慢性乙型肝炎患者口服核苷类似物抗病毒药物治疗的病毒学突破与耐药情况。方法:调查统计389例慢性乙型肝炎患者口服核苷类似物抗病毒治疗的效果、病毒突破产生及病毒耐药基因产生等情况,并进行相应分析。结果:389例慢性乙型肝炎患者接受口服抗病毒药物治疗后,93例在治疗开始1年后发生病毒学突破,其中58例检测出基因型耐药,31例发生生化学突破。在93例首次发生病毒学突破的患者中,57例1～3个月复查证实其为病毒学突破患者,28例经复查不能确定其为病毒学突破患者。57例确诊病毒学突破患者中,45例检测出基因型耐药,并且调整了治疗方案,所有患者HBV-DNA水平均有下降,最终40例患者的HBV-DNA降至最低检出范围以下;另有12例未检测出基因型耐药的患者,其中5例继续原治疗方案不变,7例调整了治疗方案,最终HBV-DNA均能降至最低检出范围以下。结论:病毒学突破在口服核苷类似物抗病毒药物治疗时比较多见,但有些病毒突破患者并不产生基因型耐药。了解治疗依从性及复查确诊病毒学突破发生情况对评估患者治疗效果及调整用药有积极意义。

To analyze the virological breakthrough and antiviral drugs resistance in patients with chronic hepatitis B who were receiving oral antiviral drugs

OBJECTIVE To investigate the incidence of virological breakthrough(VBT) and antiviral drugs resistance in patients with chronic hepatitis B(CHB) who were receiving oral nucleoside analogue(NUC) antiviral drugs in clinical practice.METHODS With retrospective study of 389 patients with CHB who were receiving NUCs,the curative effect,incidence of virological breakthrough and the genotypic resistance(GR) of the patients were analyzed.RESULTS Of 389 patients with CHB who were receiving NUCs,93 patients had VBT at 1 year,58 of which were detected to have genotypic resistance and 31 were biochemical breakthrough.57 of the 93 patients were confirmed to have VBT in 1-3 months while 28 could not be confirmed.45 of the 57 patients were detected to have GR and changed the medications.Serum HBV-DNA decreased in all 45 and 40 had undetectable HBV-DNA.12 patients of the 57 had no GR among these cases 7 patients who were changed medications had undetectable HBV-DNA and 5 patients were not changed.CONCLUSION In clinical practice VBT was usual in patients with CHB receiving NUCs,but not all VBTs were related to genotypic resistance.The patients’ medication adherence and confirmation of VBT may affect the antiviral medications.