拉米夫定和阿德福韦酯抗病毒疗效与 HBV 基因型的关系

摘要

目的：探讨慢性乙型肝炎患者应用拉米夫定、阿德福韦酯的疗效与 HBV基因型的关系。方法选取125例慢性乙型肝炎患者，分别给予拉米夫定（拉米夫定组，n＝60）和阿德福韦酯（阿德福韦酯组，n＝65）抗病毒治疗。观察2组治疗3、6、12个月后的病毒学应答率、血清学应答率及生化学应答率，并于治疗12个月后检测耐药率及耐药基因突变位点。结果拉米夫定组在治疗6、12个月后，B基因型HBV感染患者病毒学应答率、血清学应答率明显高于C基因型 HBV感染患者（P＜0．05），但生化学应答率差异无统计学意义（P＞0．05）。阿德福韦酯组在治疗期间B基因型HBV感染患者与C基因型HBV感染患者的病毒学应答率、血清学应答率、生化学应答率差异均无统计学意义（P＞0．05）。治疗12个月后，拉米夫定组耐药率明显高于阿德福韦酯组（P＜0．05），拉米夫定组和阿德福韦酯组耐药基因突变位点分别以rt108M、rt236T为主。结论拉米夫定对B基因型 HBV的抑制作用优于C基因型HBV ；阿德福韦酯的抗病毒疗效与HBV基因型无关；在慢性乙肝型炎治疗过程中要重视 HBV耐药性发生，加强疗效评估。%Objective To explore the relationship between the antiviral therapy efficacy of lamifuding and ade‐fovir dipivoxil with HBV genotypes in chronic hepatitis B (CHB) .Methods 125 cases of CHB patients were selected and treated lamivudine (lamivudine group ,n=60) and adefovir dipivoxil (adefovir dipivoxil group ,n=65) .The virus response rates ,serological response rates and biochemical response rates of two groups were observed respectively af‐ter 3 ,6 ,12 months treatment .The drug resistance rates and mutation sites of drug resistance gene were detected after 12 months treatment .Results In lamivudine group ,patients infected genotype B HBV had higher virus response rate and serological response rate than patients infected genotype C HBV after 6 and 12 months treatment (P<0 .05) , while the biochemical response rates had no significant difference between two genotypes (P>0 .05) .In adefovir dip‐ivoxil group ,there were no significant difference of virus response rates ,serological response rates and biochemical re‐sponse rates between patients infected genotype B and genotype C HBV (P> 0 .05) during treatment .After 12 months treatment ,the drug resistance rate of lamivudine group was higher than adefovir dipivoxil group (P<0 .05) . The main mutation sites of drug resistance gene of lamivudine group and adefovir dipivoxil group were rt 108M and rt236T respectively .Conclusion Lamivudine has better antiviral efficacy for genotype B HBV than genotype C HBV ,while the antiviral efficacy of adefovir dipivoxil is independent with HBV genotypes .The drug resistance of HBV should be paid attention to during treatment ,and the assessment of efficacy should also be strengthened .