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核苷类药物和干扰素对不同基因分型及基因突变的乙型肝炎治疗效果比较
作者:黄飞  胡勤明  贺新祥 
单位:荆州市中心医院 感染科, 湖北 荆州 434020
关键词:乙型肝炎 干扰素 核苷类药物 基因分型 基因突变 
分类号:R453.9
出版年·卷·期(页码):2018·46·第一期(39-42)
摘要:

目的:探讨核苷类药物和干扰素对不同基因乙型肝炎的疗效差异。方法:对431例乙型肝炎患者行基因分型和基因突变检测,根据用药分为干扰素组(n=216)和核苷类组(n=215),比较两组患者治疗48周后的效果及治疗应答率的差异。结果:HBV-B型者292例(67.75%),HBV-C型者139例(32.25%);原发性耐药基因突变患者13例,继发性耐药基因位点突变63例。治疗48周后,核苷类组患者丙氨酸氨基转移酶(ALT)复常率、HBV-DNA转阴率高于干扰素组(P<0.01),HBeAg转阴率、HBeAg转换率低于干扰素组(均P<0.05);核苷类组中HBV-B与HBV-C型患者的治疗应答率差异无统计学意义(P>0.05);原发性突变、继发性突变和未突变患者之间治疗应答率差异有统计学意义(P<0.01)。干扰素组中HBV-B患者治疗应答率明显高于HBV-C患者(P<0.05);在原发性突变、继发性突变和未突变患者之间治疗应答率差异无统计学意义(P>0.05)。结论:治疗乙型肝炎需要根据患者基因分型和基因突变情况合理选择药物;同时还要对耐药基因进行监测,当出现基因突变产生耐药时要尽快调整治疗方案,以获得最佳的治疗效果。

Objective:To investigate the diffrences ofcurative effect of nucleoside medicineand interferon on hepatitis B with different genes and mutation. Methods:Four hundreds and thirty-one cases of hepatitis B were underwent the genotyped and gene mutation detection, and then divided into interferongroup (n=216) and nucleosidegroup (n=215)according to the treatment method. After 48 weeks the curative effect and treatment response rate were compared between the two groups.Results:There were 292 cases (67.75%) of HBV-B and 139 (32.25%) cases of HBV-C. There were 13 cases of primary resistance mutation and 63 cases of secondary resistance gene mutation. After 48 weeks of treatment,the normalization rate of ALT and the negative rate of HBV-DNA in nucleoside group were higher than those in interferon group (P<0.01), HBeAg negative rate, HBeAg conversion rate were lower than those in interferon group (P<0.01).HBV-B and HBV-C type patients response rate has no significant difference (P>0.05) in nucleotide group. There was no significant difference among the primary, secondary and non-mutated patients (P<0.01). In the interferon group, the treatment response rate of the HBV-B patients was significantly higher than that of HBV-C patients (P<0.05).There was no significant difference among the primary, secondary and non-mutated patients (all P>0.05). Conclusion:The treatment of Hepatitis B should be based on the patient's genotyping and gene mutation to select drugs rationally. At the same time, the drug resistance genes should be monitored. Whenresistance caused bygene mutation happens, the treatment plan should be adjusted as soon as possible to obtain the best treatment effect.

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