HBeAg阳性慢性乙型肝炎患者 HBV基因型分布及其与抗病毒治疗疗效的关系

摘要

目的：探讨绍兴地区拉米夫定治疗乙型肝炎病毒e抗原（HBeAg）阳性慢性乙型肝炎（CHB）患者乙型肝炎病毒（ HBV）基因型的分布及其与抗病毒治疗疗效的关系。方法对122例HBeAg阳性CHB患者进行基因分型，分析接受拉米夫定抗病毒治疗1年后HBV基因型与HBV DNA、HBeAg、丙氨酸氨基转移酶（ ALT）及HBV P基因变异的关系。结果122例CHB患者中，B基因型34例（27．87％），C基因型82例（67．21％），D基因型3例（2．45％），C／D混合基因型1例（0．82％），B／C混合基因型2例（1．64％）。 B基因型感染者的HBV DNA转阴率、HBeAg转阴率显著高于C基因型感染者（P均＜0．01），HBV DNA水平显著低于C基因型感染者（P＜0．05），ALT复常率高于C基因型感染者，但差异无统计学意义（P＞0．05）。 B基因型感染者中临床表现以CHB轻度为主（44．12％），C基因型感染者临床表现以肝硬化失代偿期为主（30．49％）。 B基因型感染者发生基因变异0例，C基因型感染者发生变异4例，两者差异无统计学意义（ P＞0．05）。结论绍兴地区HBeAg阳性CHB患者HBV以C基因型为主，感染B型HBV的患者较感染C型HBV的患者对抗病毒治疗的应答为好，且临床表现较轻。%Objective To investigate the distribution of hepatitis B virus ( HBV) genotype of hepatitis B e antigen (HBeAg) positive chronic hepatitis B (CHB) patients treated by lamivudine and its relationship with the efficiency of antiviral therapy .Methods A total of 122 HBeAg positive CHB patients were genotyped and received lamivudine treatment for 1 year, and the relationships of HBV genotype with HBV DNA , HBeAg, alanine aminotransferase ( ALT) and HBV P gene variation were analyzed .Results Among the 122 HBeAg positive CHB patients , there were 34 cases of B genotype (27.87%), 82 cases of C genotype (67.21%), 3 cases of D genotype (2.45%), 1 case of C /D mixed genotype (0.82%) and 2 cases of B /C mixed genotype (1.64%).The turning negative rates of HBV DNA and HBeAg in CHB patients with genotype B were higher significantly than those with genotype C (P<0.01), and the HBV DNA level was lower significantly than that with genotype C (P<0.05).The rate of normalization ALT was higher than that with genotype C, but had no statistical significance (P>0.05).Genotype B group were mainly patients with mild CHB (44.12 %), while genotype C group were mainly patients with uncompensated liver cirrhosis (30.49%). Genotype B infection group had no gene variation , there were 4 cases of variation in genotype C infection group , and there was no statistical significance(P>0.05).Conclusions HBV genotype C of HBeAg positive CHB patients is the major genotype in Shaoxing .HBV patients with geotype B infection have better response for antiviral therapy than those with genotype C infection , and the clinical manifestation is light .