B、C基因型及拉米夫定抗HBV疗效比较.docVIP

B、C基因型及拉米夫定抗HBV疗效比较【摘要】 目的 了解乙肝病毒(HBV)B、C基因型与拉米夫定抗HBV的关系。方法 采用前瞻性和回顾性相结合的方法收集资料，患者口服拉米夫定100 mg/d治疗至少12个月，停药观察至少6个月。采用多引物对巢式PCR法检测HBV基因型。结果 共收集并检测出C基因型24例，B基因型22例。B、C基因型患者的病毒学应答在服药6个月、服药12个月及停药时无统计学意义，停药6个月后的病毒学应答有统计学意义，B基因型优于C基因型。结论 B基因型患者停药6个月后的持续病毒学应答优于C基因型。 【关键词】乙型肝炎病毒；基因分型；拉米夫定 The virology response of lamivudine with HBV genotype B compare with genotype C ZHOU Dong-sheng,LUO Guang-han,JIANG Jian-ning,et al.Department of Infectious Diseases,the First Affiliated Hospital of Guilin Medical College Guilin 541001,China 【Abstract】 Objective To evaluate the antiviral response of lamivudine treatment between HBV genotypes B and C in chronic patients with HBV infection.Methods Clinical data was collected by prospective method linked retrospective method.The patients with HBV infection received lamivudine 100 mg/d,oral application for at least 12 months and observed regularly until 6 months after drug withdrawal.HBV genotype was determined by the nested PCR with multiple x pairs of primers.Results There were 22 patients of genotype B and 24 of genotype C.The virology respond was not significant difference between genotype B and Genotype C at time of 6 months,12 months and the time of drug withdrawal.It was significant difference at 6 months after drug withdrawal.Conclusion The sustained virology respond with genotype B was higher than with genotype C after 6 month of lamivudine withdrawal. 【Key words】Hepatitis B virus；Genotype；Lamivudine 国外众多报道干扰素抗病毒治疗效果与HBV基因型有密切的关系，但对HBV基因型与拉米夫定抗HBV疗效关系的报道较少，HBV基因型与拉米夫定停药后病毒学持续应答的关系更鲜有报道[1,2]。为此我们结合近年来拉米夫定在我国的广泛使用和HBV基因型在我国的分布情况，探讨B、C基因型与拉米夫定抗HBV疗效之间的关系，为临床治疗前评估、优化治疗方案提供依据。 1 材料和方法 1．1材料来源 血清采自2000年1月至2004年10月广西医科大学第一附属医院门诊和住 院患者，采用前瞻性和回顾性相结合的方法收集资料。所有乙肝诊断标准符合2000年“全国第十次病毒性肝炎学术会议”修订的病毒性肝炎诊断标准[3]。 1．2 患者选择 1．2．1 入选标准 ①年龄16~65岁，治疗前血清HBV-DNA阳性；②服用拉米夫定100 mg/d,疗程至少1年,停药观测至少半年；③患者依从性好，定期复查肝功能、两对半、HBV-DNA定量；④多引物对巢式PCR法检测HBV基因型为B型或为C型。 1．2．2 剔除标准 ①抗 HCV、抗HDV或抗HIV阳性；②肝癌，肝硬化，骨髓抑制，肾功能异常；③有严重器质性疾病，精神病，嗜酒，吸毒；④筛选