肝组织HBV DNA在抗病毒治疗中的变化与作用

中国临床药理学与治疗学 ›› 2007, Vol. 12 ›› Issue (3): 352-356.

肝组织HBV DNA在抗病毒治疗中的变化与作用

陆海英¹, 庄立伟¹, 于岩岩¹, 斯崇文¹, 李俊¹, 陈新月², 韩忠厚³, 陈勇⁴

¹北京大学第一医院感染疾病科, 北京100034;
²北京佑安医院, 北京100054;
³秦皇岛第三医院, 秦皇岛066000, 河北;
⁴江苏淮阴传染病医院, 淮阴223300, 江苏

收稿日期:2007-01-09 修回日期:2007-02-13 出版日期:2007-03-26 发布日期:2020-11-06
通讯作者: 斯崇文, 男, 本科, 教授, 博导, 研究方向:病毒性肝炎。Tel:010-66551122-2362 E-mail:bjsichongwen@sina.com
作者简介:陆海英, 女, 博士, 副教授、副主任医师, 研究方向:病毒性肝炎。Tel:010-66551122-2370 E-mail:luhaiying00@126.com
基金资助:
北京市科委重大项目资助(H020920020690)

Role of intrahepatic HBV DNA in antivirus therapy

LU Hai-ying¹, ZHUANG Li-wei¹, YU Yan-yan¹, SI Chong-wen¹, LI Jun¹, CHEN Xin-yue², HAN Zhong-hou³, CHEN Yong⁴

¹Department of Infectious Disease, Peking University First Hospital, Beijing 100034, China;
²Beijing Youan Hospital, Beijing 100054, China;
³Qinhuangdao Third Hospital, Qinhuangdao 066000, Hebei, China;
⁴Huaiyin Infeetions disease Hospital Jiangsu Provinee, Huaiyin 223300, Jiangsu, China

Received:2007-01-09 Revised:2007-02-13 Online:2007-03-26 Published:2020-11-06

摘要/Abstract

摘要： 目的:探讨肝组织HBV DNA 在抗病毒治疗中的变化及其作用。方法:71 例HBeAg 阳性的慢性乙肝患者分别接受序贯治疗、拉米夫定和干扰素抗病毒治疗, 总疗程为48 周, 随访24 周。检测治疗前、后肝组织HBV DNA 。用限制性片段长度多态性方法进行HBV 基因分型。结果:应答者肝组织HBVDNA 基线值明显低于其它组患者(P =0.0013), 治疗48 周后其对数均值从5.9 ±1.0 降至4.5 ±1.2,明显低于无应答或反跳患者(P =0.0073) 。治疗48周肝组织HBV DNA 对数浓度<5 的患者, 肝组织HBV DNA 对数均值从5.8 ±1.0 降至3.8 ±0.9, 明显低于治疗48 周肝组织HBV DNA 对数浓度>5 的患者(P =0);但停药24 周后, 两组患者血HBV DNA及ALT 均值均无统计学差异(P >0.05) 。停药24周后出现反跳的患者, 其治疗前、后各项指标与持续应答者无统计学差异(P >0.05) 。C 基因型(61 例)和B 基因型(10 例) 慢乙肝患者肝组织HBV DNA 含量治疗前、后无统计学差异。结论:抗病毒治疗可明显抑制肝组织HBV DNA 的含量, 肝组织HBV DNA低水平患者易获得较好的疗效。肝细胞内HBVDNA 的消失可能是判断抗病毒治疗终点的理想指标。C 、B 基因型慢乙肝患者肝组织HBV DNA 含量无明显差异, 抗病毒治疗疗效相近。

关键词: 序贯治疗, 拉米夫定, 干扰素, HBV DNA, 肝组织学

Abstract: AIM: To study the role of intrahepatic HBV DNA in antiviral therapy.METHODS: 71 patients with HBeAg-positive chronic hepatitis B were studied. Twelve patients were treated with INF-α2b;thirty-five patients received lamivudine;twenty-four patients were administered by sequential therapy with Lamivudine-INF-α2b (at first, lamivudine alone from first to 6th month, then lamivudine combined with INF-α2b from 7th to 8th month, finally INF-α2b alone from 9th to 12th month). Liver biopsy specimens were obtained before and after treatment.Blood samples were collected once a month during the period of treatment, in the thirdmonth, and in the sixth month after cessation of therapy.Serum and intrahepatic HBV DNA were measured quantitatively by real-time polymerase chain reaction.HBV genotypes were analyzed by PCR-RFLP.RESULTS: There was no significant difference in intrahepatic HBV DNA levels between the patients infected by HBV genotype C (60 cases) and genotype B (10 cases) (P >0.05).Intrahepatic HBV DNA logarithm levels in the patients with therapy response decreased from (5.9 ±1.0) to (4.5 ±1.2) (P <0.05).Patients with intrahepatic HBV DNA logarithm level <5 after treatment achieved higher serum HBV DNA undetectable rate and serum ALT normalization.However, after withdrawal of antiviral drugs, the mean levels of serum HBV DNA and ALT flared up.CONCLUSION: The intrahepatic HBV DNA load can be significantly inhibited by antiviral agents.The patients with lower levels of intrahepatic HBV DNA have better therapy response. Intrahepatic HBV DNA loss may be a significant marker for the endpoint of antiviral treatment.There is no significant difference in intrahepatic HBV DNA levels between the patients infected with HBV genotype C and genotype B.

Key words: sequential treatment, lamivudine, interferon, HBV DNA, liver histology

中图分类号:

R512

陆海英, 庄立伟, 于岩岩, 斯崇文, 李俊, 陈新月, 韩忠厚, 陈勇. 肝组织HBV DNA在抗病毒治疗中的变化与作用[J]. 中国临床药理学与治疗学, 2007, 12(3): 352-356.

LU Hai-ying, ZHUANG Li-wei, YU Yan-yan, SI Chong-wen, LI Jun, CHEN Xin-yue, HAN Zhong-hou, CHEN Yong. Role of intrahepatic HBV DNA in antivirus therapy[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2007, 12(3): 352-356.

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