CAJ | 학술논문

目的：探讨乙型肝炎病毒（HBV）基因型亚型与核苷类似物抗病毒疗效的关系。方法收集159例慢性乙型肝炎（CHB）患者的临床资料，据患者病情给予阿德福韦酯（ADV）或恩替卡韦（ETV）抗病毒治疗。应用巢式聚合酶链反应检测患者的基因型及亚型。于治疗前、治疗24周及48周，分别检测 HBV DNA 定量、ALT 水平以及血清病毒学标志物。分析 HBV 不同基因型、亚型与 ADV 及 ETV 抗病毒疗效的关系。结果（1）159例样本中 B 基因型26例（16．4％），均为 Ba 亚型；C 基因型128例（80．5％），均为 C2亚型，Ba／C2混合亚型5例（3．1％），未检出其他基因型。（2）ADV 治疗24周时 Ba 亚型与 C2亚型的 ALT 复常率为66.7％与66．2％（χ2＝0．74），HBeAg 转阴率为27．3与23．1％（χ2＝0．10），HBV DNA 转阴率为33．3％与30.9％（χ2＝0．03），治疗48周时 Ba 亚型以及 C2亚型的 ALT 复常率为83．3％与82．4％（χ2＝0．01），HBeAg 转阴率为45．5与34．4％（χ2＝0．49），HBV DNA 转阴率为58．3％与48．5％（χ2＝0．39），差异均无统计学意义（均 P ＞0.05）。ETV 治疗24周时 Ba 亚型以及 C2亚型的 ALT 复常率为71．4％与69．6％（χ2＝0．02），HBeAg 转阴率为33．3％与30．8％（χ2＝0．03），HBV DNA 转阴率为42．9％与39．3％（χ2＝0．06），治疗48周时 Ba 亚型与 C2亚型的 ALT 复常率为85．7％与83．9％（χ2＝0．03），HBeAg 转阴率为50．0％与44．9％（χ2＝0.10），HBV DNA转阴率为71．4％与67．8％（χ2＝0．07），差异均无统计学意义（均 P ＞0．05）。结论山西地区慢性乙型肝炎患者的 HBV 基因型、亚型以 C 基因型及 C2亚型为主。ADV 及 ETV 抗病毒疗效与 HBV 基因型、亚型无关。
목적：탐토을형간염병독（HBV）기인형아형여핵감유사물항병독료효적관계。방법수집159례만성을형간염（CHB）환자적림상자료，거환자병정급여아덕복위지（ADV）혹은체잡위（ETV）항병독치료。응용소식취합매련반응검측환자적기인형급아형。우치료전、치료24주급48주，분별검측 HBV DNA 정량、ALT 수평이급혈청병독학표지물。분석 HBV 불동기인형、아형여 ADV 급 ETV 항병독료효적관계。결과（1）159례양본중 B 기인형26례（16．4％），균위 Ba 아형；C 기인형128례（80．5％），균위 C2아형，Ba／C2혼합아형5례（3．1％），미검출기타기인형。（2）ADV 치료24주시 Ba 아형여 C2아형적 ALT 복상솔위66.7％여66．2％（χ2＝0．74），HBeAg 전음솔위27．3여23．1％（χ2＝0．10），HBV DNA 전음솔위33．3％여30.9％（χ2＝0．03），치료48주시 Ba 아형이급 C2아형적 ALT 복상솔위83．3％여82．4％（χ2＝0．01），HBeAg 전음솔위45．5여34．4％（χ2＝0．49），HBV DNA 전음솔위58．3％여48．5％（χ2＝0．39），차이균무통계학의의（균 P ＞0.05）。ETV 치료24주시 Ba 아형이급 C2아형적 ALT 복상솔위71．4％여69．6％（χ2＝0．02），HBeAg 전음솔위33．3％여30．8％（χ2＝0．03），HBV DNA 전음솔위42．9％여39．3％（χ2＝0．06），치료48주시 Ba 아형여 C2아형적 ALT 복상솔위85．7％여83．9％（χ2＝0．03），HBeAg 전음솔위50．0％여44．9％（χ2＝0.10），HBV DNA전음솔위71．4％여67．8％（χ2＝0．07），차이균무통계학의의（균 P ＞0．05）。결론산서지구만성을형간염환자적 HBV 기인형、아형이 C 기인형급 C2아형위주。ADV 급 ETV 항병독료효여 HBV 기인형、아형무관。
Objective To investigate the relationship between the genotype /sub -genotype and antiviral treatment.Methods The clinical data of 159 patients with chronic HBV infections were collected,who were treated by adefovir dipivoxil (10mg/d)or entecavir(0.5mg/d)according to the disease′s conditions.The genotypes and subtypes of hepatitis B virus were determined by Nested polymerase chain reaction(nt PCR).The levels of serum HBVDNA replication,ALT levels and HBV serologic markers were detected pre or post -treatment 24 weeks, 48 weeks.Observed the relationship between the HBV genotypes/sub -genotypes and the antiviral efficacy of adefovir dipivoxil or entecavir treatment.Results After 24 weeks of adefovir dipivoxil therapy,ALT normalization rate of subgenotype Ba and subgenotype C2 was 66.7% vs 66.2%(χ2 =0.74,P >0.05),HBeAg negative conversion rate of two subgenotypes was 27.3% vs 23.1%(χ2 =0.10,P >0.05),HBVDNA negative conversion rate of two sub genotype Ba and subgenotype C2 was 33.3% vs 30.9%(χ2 =0.03,P >0.05),respectively.After treatment for 48 weeks,ALT normalization rates of subgenotype Ba and subgenotype C2 were 83.3% vs 82.4%(χ2 =0.01,P >0.05),HBeAg negative conversion rates of two subgenotypes were 45.5% vs 34.4%(χ2 =0.49,P >0.05 ),HBVDNA negative conversion rates of two subgenotypes were 58.3% vs 48.5%(χ2 =0.39,P >0.05).After 24 weeks of entecavir therapy, ALT normalization rates of subgenotype Ba and subgenotype C2 were 71.4% vs 69.6%(χ2 =0.02,P >0.05 ), HBeAg negative conversion rates of two subgenotypes were 33.3% vs 30.8%(χ2 =0.03,P >0.05 ),HBVDNA negative conversion rates of two subgenotypes were 42.9% vs 39.3%(χ2 =0.06,P >0.05 ),respectively.After treatment for 48 weeks,ALT normali zation rates of subgenotype Ba and subgenotype C2 were 85.7% vs 83.9%(χ2 =0.03,P >0.05),HBeAg negative conversion rates of two subgenotypes were 50.0% vs 44.9%(χ2 =0.10, P >0.05),HBVDNA negative conversion rates of two subgenotypes were 71.4%vs 67.8%(χ2 =0.07,P >0.05). Conclusion The study showed that genotype C(C2)is a predominant HBV genotype among people with chronic HBV infections in Shanxi province.HBV subgenotypes Ba and C2 have no significant difference in virologic,biochemi-cal,and immunologic response to ADV or ETV.