预存耐药对核苷(酸)类似物抗病毒治疗应答和耐药的影响

盖洪鹏; 孙伟翔; 袁德胜; 常青山; 姜升; 石龙

预存耐药对核苷(酸)类似物抗病毒治疗应答和耐药的影响

大连市第六人民医院肝病科

详细信息

中图分类号: R512.62
计量
- 文章访问数: 336
- HTML全文浏览量: 11
- PDF下载量: 115
- 被引次数: 0
出版历程
- 出版日期: 2012-11-20

The clinical implications of detecting pre-existing resistance to nucleos(t)ide analogue-based antiviral therapy

摘要

摘要:
目的了解预存耐药检测对核苷（酸）类似物抗病毒治疗的影响。方法 127例慢性乙型肝炎患者,分治疗组与对照组。治疗组患者用药前进行预存耐药检测,对照组不进行测序。疗程96周,停药后随访24周。结果预存耐药检出率为17.19%;治疗后总耐药发生率治疗组低于对照组（P<0.01）。48周、96周HBV DNA阴转率、HBeAg/抗-HBe血清学转换率治疗组均高于对照组（P<0.05）。结论预存耐药与核苷（酸）类似物耐药和治疗应答密切相关;治疗前进行预存耐药检测对指导临床个体化抗病毒治疗和预防耐药的发生有实用价值。
- 肝炎,乙型,慢性 /
- 核甘酸类 /
- 抗病毒药
Abstract:
Objective To study the clinical benefit of detecting pre-existing resistance to nucleos (t) ide analogue-based anti-viral therapy.Methods One-hundred-and-twenty-seven patients with chronic hepatitis B were enrolled in the study.Sixty-four of the cases were assigned to the experimental group, in which the hepatitis B virus (HBV) DNA was sequenced to detect the known nucleos (t) ide analogue-resistance mutations prior to treatment initiation.The remaining 63 cases were administered treatment without prior sequencing.The nucleos (t) ide analogue treatment course lasted 96 weeks, and all patients were followed-up for 24 weeks after treatment discontinuation.Results The pre-existing resistance detection rate was 17.2%.The total incidence of resistance was lower in the detected group than in the control group (P < 0.01) .After treatment for 48 weeks and 96 weeks, the HBV DNA-negative conversion rate and the hepatitis B e antigen (HBeAg) /anti-HBe antibody serological conversion rate were both higher in the detected group than in the control group (P < 0.05) .Conclusion s Since pre-existing resistance to nucleos (t) ide analogues is a critical determinant of a patient’s response to treatment, detecting known nucleos (t) ide analogue-resistance mutations by genotyping prior to treatment initiation has practical value to guide individualized antiviral treatment and prevent the complications associated with inappropriate treatment of drug-resistant patients.
- biopsy /
- hepatitis /
- chronic

HTML全文

参考文献(12)

[1] 刘峰, 张欣欣.乙型肝炎病毒准种与核苷 (酸) 类似物耐药[J].中华传染病杂志, 2010, 28 (3) :186-188.

[2]Zhang X, Liu C, Gong Q, et al.Evolution of wild type and mutantsof the YMDD motif of hepatitis B virus polymerase during lamivudi-ne therapy[J].J Gastroenterol Hepatol, 2003, 18 (12) :1353-1357.

[3]Wang F, Wang H, Shen H, et al.Evolution of hepatitis B viruspolymerase mutations in a patient with HBeAg-positive chronichepatitis B virus treated with sequential monotherapy and add-onnucleoside/nucleotide analogues[J].Clin Ther, 2009, 31 (2) :360-366.

[4]中华医学会.病毒性肝炎防治方案[J].中华传染病杂志, 2001, 19 (1) :56-62.

[5] 中华医学会肝病学分会中华医学会感染病学分会.慢性乙型肝炎防治指南[J].临床肝胆病杂志, 2006, 22 (1) :3-15.

[6]Liu F, Chen L, Yu DM, et al.Evolutionary patterns of hepatitis Bvirus quasispecies under different selective pressures:correlationwith antiviral efficacy[J].Gut, 2011, 60 (9) :1269-1277.

[7]张欣欣.乙型肝炎病毒异质性与抗病毒治疗应答[J].临床肝胆病杂志, 2011, 27 (12) :1262-1265.

[8]Chen L, Zhang Q, Yu DM, et al.Early changes of hepatitis B virusquasispecies during lamivudine treatment and the correlation withantiviral efficacy[J].J Hepatol, 2009, 50 (5) :895-905.

[9]Han Y, Huang LH, Liu CM, et al.Characterization of hepatitis Bvirus reverse transcriptase sequences in Chinese treatment nave pa-tients[J].J Gastroenterol Hepatol, 2009, 24 (8) :1417-1423.

[10]Zeuzem S, Gane E, Liaw YF, et al.Baseline characteristics andearly on-treatment response predict the outcomes of 2 years of tel-bivudine treatment of chronic hepatitis B[J].J Hepatol, 2009, 51 (1) :11-20.

[11]刘元天, 朴荣利, 刘睿.拉米夫定抗病毒治疗慢性乙型肝炎的临床研究[J].临床肝胆病杂志, 2010, 26 (3) :334-336.

[12]宋闽宁, 张丽, 黄文琪, 等.阿德福韦酯治疗慢性乙型肝炎3年临床观察与耐药分析[J].临床肝胆病杂志, 2010, 26 (1) :22-24.

施引文献

资源附件(0)

访问统计