不同HBV基因型感染慢性乙型肝炎患者对核苷(酸)类药物治疗的应答反应比较

目的研究与探讨HBV基因型与慢性乙型肝炎患者肝组织病理学变化及对核苷(酸)类抗病毒药物疗效的关系。方法随机将慢性HBV感染者541例分为4组:拉米夫定组136例、替比夫定组135例、恩替卡韦组135例和阿德福韦组135例,各治疗48周。治疗前应用聚合酶链反应法确定HBV基因型,并于治疗前和治疗48周时分别检测肝功能、HBV DNA和HBV M。其中109例行肝组织病理学检查。结果本组HBV B基因型94例(17.38%),C型410例(75.79%),B/C混合型37例(6.84%),未检出其他基因型;在B型感染者,肝组织G3占37.3%、S313.0%,C型感染者G3占8.7%、S3占22.7%,B基因型与C基因型之间比较,有统计学意义(P<0.05);在拉米夫定、恩替卡韦和替比夫定治疗患者,B型、C型和B/C混合型之间疗效的比较,有统计学差异(P<0.05),而在阿德福韦酯治疗患者,几种不同的基因型感染患者疗效无统计学差异(P>0.05)。结论 HBV基因型与患者肝组织病理学改变及对核苷类抗病毒治疗的疗效密切相关。

Relationship of HBV genotypes to changes of liver biopsies and to responses to antiviral therapy of nucleoside analogs

Objective To investigate the relationship of HBV genotype to liver biopsy and the antiviral therapy of nucleoside analogs.Methods We collected 541 patients with chronic hepatitis B virus infection.The patients were divided into 4 groups at random,e.g.lamivudine(n=136),telbivudine(n=135),entecavir(n=135)and adefovir(n=135cases).The treatment lasted for 48 weeks.The genotype of HBV were determined by PCR before therapy.We also checked the liver function,HBV DNA and HBV M.Moreover,we performed the liver biopsies in 109 cases.Results The genotype B of HBV was 94 cases(17.38%),type C was 410 cases(75.79%),the type B/C was 37 cases(6.84%),and no other types of genotype had been detected;in HBV genotype B,G3 in liver tissues accounted for 37.3% and S3 for 13.0%,while in HBV genotype C,G3 accounted for 8.7% and S3 for 22.7%(P<0.05);in patients treated with lamivudine,telbivudine or entecavir,the efficacy in genotype B was better than patients with genotype C and B/C infection(P<0.05).when we used adefovir therapy,there was no statistical significance(P>0.05)between genotype B and genotype C or B/C infection.Conclusion HBV genotype has close relationship with liver lesions and the antiviral therapy of nucleosides.