山东医药2017，Vol.57Issue(40)：1-4,4.DOI:10.3969/j.issn.1002-266X.2017.40.001
HBVrt A181 T/V突变慢乙肝患者的抗病毒治疗史、血清学特点及恩替卡韦挽救治疗效果观察
Antiviral therapy history, serological characteristics, and entecavir salvage therapeutic effect in HBVrtA181T/V mutant patients with chronic hepatitis B
摘要
Abstract
Objective To observe the history of antiviral therapy , serological characteristics , and entecavir salvage therapeutic effect in the hepatitis B virus ( HBV) reverse transcriptase ( RT) 181 site T/V mutant patients with chronic hepatitis B.Methods Seventy-one patients with virological breakthrough of nucleoside (acid) analogues (NAs)-resistant hepatitis B were continuously enrolled .Using direct sequencing for HBV sequencing , and we confirmed the presence of HBV reverse transcriptase region 181 site mutation of T/V, including 41 cases of HBV reverse transcriptase region 181 site mutation of T (rtA181T), and 30 cases of HBV reverse transcriptase region 181 site mutation of V (rtA181V).The medi-cation history of NAs in 71 patients was reviewed .The levels of serum ALT , HBsAg, and HBV-DNA were detected and compared in rtA181T and rtA181V patients during virological breakthrough .All patients were treated with entecavir-based antiviral therapy, and then we compared the virological response of rtA 181T and rtA181V patients at 24 and 52 weeks. Results Of the 71 patients, 25 patients were treated with a single antiviral drug (adefovir dipivoxil), and 46 patients with sequential or combined use of multiple NA .When the HBV rtA181T and rtA181V patients had virological breakthrough , the levels of serum ALT were 55 (15, 474) and 49 (16,183) U/mL, respectively, P>0.05; the log10 of HBV-DNA were 5.71 ±1.02 and 6.04 ±0.97, respectively, P<0.05; the log10 of serum HBsAg were 3.36 ±0.50 and 3.64 ± 0.60, P<0.05.Salvage therapy with entecavir was mainly for 24 weeks.The complete virologic response was found in 55 cases (77.5%), including 33 cases (80.5%) of HBV rtA181T patients and 22 cases (73.3%) of HBV rtA181V pa-tients;incomplete virologic response was found in 16 cases (22.5%).After 52 weeks of treatment, the complete virologic response was found in 62 cases (87.3%), including 37 cases (90.2%) of HBV rtA181T patients and 25 cases (83.3%) of HBV rtA181V patients;incomplete virologic response was found in 9 cases (12.7%), and no significant difference was found in the virologic response between the HBV rtA 181T and rtA181V patients (P>0.05).Conclusions Patients with HBV rtA181T/V mutation are mostly treated with sequential or combined with adefovir dipivoxil , lamivudine and other NAs.Serum HBsAg is higher in HBV rtA181V patients than in patients with HBV rtA 181T.The treatment effect of HBV rtA181T/V patients treated with entecavir salvage is satisfactory , but the treatment effect is not different between HBV rtA181T and HBV rtA181V patients.关键词
慢性乙型肝炎/乙型肝炎病毒/基因突变/逆转录酶区/拉米夫定/阿德福韦酯/替比夫定/恩替卡韦/病毒学应答Key words
chronic hepatitis B/hepatitis B virus/gene mutation/reverse transcriptase/lamivudine/adefovir dipiv-oxil/entecavir/telbivudine/virological response分类
医药卫生引用本文复制引用
薛艳,高林,王磊,张立新,刘峰,曲云东,杨保华,李涛,王岩,叶茜..HBVrt A181 T/V突变慢乙肝患者的抗病毒治疗史、血清学特点及恩替卡韦挽救治疗效果观察[J].山东医药,2017,57(40):1-4,4.基金项目
山东省自然科学基金资助项目(ZR2014HL088) （ZR2014HL088）
济南市临床医学科技创新计划(201506004) （201506004）
山东大学第二医院青年基金资助项目(Y2014010014). （Y2014010014）
