| [Objective]To study genotypes and subgenotypes of hepatitis B virus (HBV) in chronic hepatitis B (CHB) patients in Fujian province and variables influencing the efficacy of antiviral therapy.[Method]170 CHB patients with HBeAg positive were randomly divided into four groups. 48 patients in group A received onlyα-IFN 5 MIU therapy every two day for 24 weeks. In group B, 41 patients received 100 mg lamivudine every day to end of therapy and in this course after treated with only lamivudine for 8 weeks,α-IFN therapy was added for 16 weeks. While in group C, 43 patients were treated with 100 mg lamivudine every day alone for 8 weeks, followed by bothα-IFN and lamivudine for 8 weeks, lastly withα-IFN alone for 20 weeks. In group D, 38 patients received only lamivudine 100 mg every day to end of therapy . Six months later after the therapy terminated in group A and C and the therapy lasting for one /one and a half years in group B and D, efficacy of therapy were compared. The relationship between response of therapy and influencing factors, such as genotypes /subgenotypes of hepatitis B virus, the level of baseline ALT, HBVDNA before therapy and treatment plan, were analyze by Kruskal-Wallis H test and chi-square test.[Result]1. Genotypes of HBV in all patients were genotype B or C, 69.06% and 30.94% respectively. And most subgenotypes of all were Ba or C2, except for one mixed C1 and C2 type.2. In the end of therapy, the normalizing rate of ALT in group A and C was 68.8% and 58.1% respectively (P=0.293); the rate of seroconversion was 35.4% and 18.6% respectively(P=0.073);negative rate of serum HBV DNA was 18.8% and 23.3% respectively (P=0.598). Six months later after the therapy terminated in group A and C, the corresponding rate was 65.1% and 48.6% respectively (P=0.141); 25.6% and 22.9% respectively (P=0.781); 27.9% and 22.9% respectively (P=0.611). In group B and D, when lamivudine therapy last for one year, the normalizing rate of ALT was 80.5% and 76.3% respectively (P=0.652); the rate of seroconversion was 34.1% and 39.5% respectively(P=0.624); negative rate of serum HBV DNA was 53.7% and 55.3% respectively (P=0.886). When the therapy last for 18 months, the corresponding rate was 76.0% and 76.2% respectively (P=0.988); 32.0% and 33.3% respectively (P=0.923); 44.0% and 57.1% respectively (P=0.375). 3. There was no relationship between the response to the therapy and baseline HBV-DNA levels, HBV genotype and subgenotype. 4. In group A , the group with baseline ALT≥4×ULN was significant higher rate of DNA<105 and negative rate of serum HbeAg than those with baseline ALT<4×ULN(73.7%vs44.8%,X2=3.884 P=0.049;73.7%vs44.8%,X2=5.880 P=0.0150).In group C, the patients with baseline ALT≥4×ULN had higher negative rate of HbeAg and the rate of complete response than those with baseline ALT≥4×ULN(X2=5.126 P=0.024,X2=7.459 P=0.006).[Conclusion]1. HBV B genotype was major genotype in Fujian province. All of genotype B were subgenotype Ba. And C2 was major subgenotype of genotype C.2. The sequential therapy with lamivudine andα-IFN was not more effective than monotherapy with lamivudine orα-IFN.3. There was no relationship between the efficacy of therapy and baseline HBV-DNA levels,HBV genotype and subgenotype4. Baseline ALT level was a influencing factor ofα-IFN therapy. |
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