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目的调查本地区乙型肝炎病毒(HBV)基因分型的分布情况,观察乙型肝炎基因分型对阿德福韦酯抗病毒疗效的影响。方法对285例慢性乙型肝炎(其中HBV基因型B型219例,C型66例)用阿德福韦酯治疗的慢性乙型肝炎的患者进行分析,观察治疗12周、24周、48周及96周丙氨酸转氨酶(ALT)、HBV DNA定量、乙型肝炎病毒e抗原(HBeAg)乙型肝炎病毒e抗体定量。结果阿德福韦酯治疗12周时B组以及C组HBV DNA转阴率为30.6%及36.4%,HBV DNA下降均值为(1.36±0.98)copies/ml及(1.31±1.40)copies/ml(P>0.05);治疗24周两组HBV DNA转阴率分别为33.8%及42.4%,HBV DNA下降均值为(2.19±1.18)copies/ml及(2.22±1.10)copies/ml(P>0.05)。治疗48周两组HBV DNA转阴率分别为38.8%及45.5%,HBV DNA下降均值为(2.98±1.24)copies/ml及(2.97±0.92)copies/ml(P>0.05)。治疗96周两组HBV DNA转阴率分别为44.8%及48.5%,HBV DNA下降均值为(3.41±1.68)copies/ml及(3.50±1.72)copies/ml(P>0.05)。治疗12周后B、C两组HBeAg转阴HBeAb出现分别为10.6%vs 8.6%及11.6%vs 9.3%,24周后B、C两组HBeAg转阴/HBeAb出现分别为14.6%vs 11.3%及16.3%vs 11.6%,48周后B、C两组HBeAg转阴/HBeAb出现分别为27.8%vs 21.2%及25.6%vs 20.9%,96周后B、C两组HBeAg转阴/HBeAb出现分别为36.4%vs 25.2%及39.5%vs 25.6%,两组差异均无统计学意义(P>0.05)。两组ALT复常率12周为59.8%vs 47.0%(P<0.05),24周为60.3%vs 63.6%,48周为76.3%vs 77.3%,96周为80.0%vs 80.3%,两组差异均无统计学意义(P>0.05)。结论阿德福韦酯治疗慢性乙型肝炎B型及C型,病毒应答、生化应答及血清学应答相当,阿德福韦酯对HBV基因B型及C型疗效无明显影响。本地区HBV基因型以B型为主,C型次之,未发现A、D型。
Objective To investigate the distribution of hepatitis B virus (HBV) genotypes in this area and to observe the effect of hepatitis B genotyping on the efficacy of adefovir dipivoxil. Methods 285 cases of chronic hepatitis B (HBV genotype B 219 cases, 66 cases of C) with adefovir dipivoxil treatment of chronic hepatitis B patients were analyzed for treatment of 12 weeks, 24 weeks, 48 weeks And 96 weeks alanine aminotransferase (ALT), HBV DNA quantification, hepatitis B virus e antigen (HBeAg) hepatitis B virus e antibody quantitation. Results After 12 weeks of adefovir dipivoxil treatment, the HBV DNA negative rates in group B and C were 30.6% and 36.4%, and the average HBV DNA levels were (1.36 ± 0.98) copies / ml and (1.31 ± 1.40) copies / ml (2.19 ± 1.18) copies / ml and (2.22 ± 1.10) copies / ml, respectively (P> 0.05). The negative rates of HBV DNA in the two groups after treatment for 24 weeks were 33.8% and 42.4% . After 48 weeks of treatment, the HBV DNA negative rates in the two groups were 38.8% and 45.5% respectively, and the mean values of HBV DNA drop were (2.98 ± 1.24) copies / ml and (2.97 ± 0.92) copies / ml respectively (P> 0.05). After treatment for 96 weeks, the HBV DNA negative rates in the two groups were 44.8% and 48.5% respectively, and the mean values of HBV DNA decreased (3.41 ± 1.68) copies / ml and (3.50 ± 1.72) copies / ml respectively (P> 0.05). After 12 weeks of treatment, HBeAg negative HBeAb in groups B and C were 10.6% vs 8.6% and 11.6% vs 9.3%, respectively. After 24 weeks, HBeAg negative HBeAb in groups B and C were 14.6% vs 11.3% and 16.3% vs 11.6%. After 48 weeks, HBeAg negative / HBeAb in group B and C were 27.8% vs 21.2% and 25.6% vs 20.9%, respectively. After 96 weeks, HBeAg negative / HBeAb in group B and C were 36.4% vs 25.2% and 39.5% vs 25.6%, respectively, with no significant difference between the two groups (P> 0.05). The normalization rate of ALT in both groups was 59.8% vs 47.0% (P <0.05) at 12 weeks, 60.3% vs 63.6% at 24 weeks, 76.3% vs 77.3% at 48 weeks and 80.0% vs 80.3% at 96 weeks No statistical significance (P> 0.05). Conclusions Adefovir dipivoxil treatment for chronic hepatitis B type B and C type, the virus response, biochemical response and serological response was equivalent, adefovir dipivoxil on HBV genotype B and C no significant effect. HBV genotypes in this region are mainly type B, followed by type C, but no type A or D is found.