CAJ | 학술논문

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.
목적 탐토감숙성만성을형간염(CHB)환자기인형적분포,이급아덕복위지(ADV)등핵감유사물(NAs)치료중내약여HBV기인형、용약방식적관계.방법 란주대학제일의원자2009년1월지2011년1월수치적87례CHB환자,근거시부응용핵감유사물치료분위치료조(n=75)화대조조(n=12).검측병비교량조환자적HBsAg、간공능、HBV DNA화HBV기인형급내약위점.결과 입조CHB환자중기인C형72례(82.76％),B형9례(10 34％),D형5례(5 75％),F형1례(1.15％).기중치료조48례출현내약,내약솔64.00％,대조조3례내약,내약솔25.00％,차이구유통계학의의(x2=6.487,P＜0.05).치료조중,ADV단약치료18례,내약솔위61.11％,서관혹연합치료24례,내약솔66.67％,내약솔지간차이무통계학의의(x2 =0.138,P＞ 0.05); ADV치료적CHB병례중기인C형34례,내약솔70.59％,B형5례,내약솔60.00％,불동기인형적내약솔차이무통계학의의(P＞0.05).결론 감숙지구HBV기인이C형위주,이ADV치료후불동기인형대내약영향불대,용약방식대내약솔야무명현영향.
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 University 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(1.15％) 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 (x2 =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 ADVsequential or combined treatment in the treated group,the resistance rate of them was 66.67％.There was no difference between the different medication way (x2 =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).Conalusions 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.