摘要目的 观察替诺福韦及替比夫定对贵州地区不同基因型HBeAg阳性的乙肝孕妇HBVDNA及HBV RNA的影响.方法 收集2016年5月—2017年7月在贵州医科大学附属医院感染科及产科门诊就诊的HBsAg,HBeAg双阳性乙肝孕妇共75例,19 ～38岁,中位年龄26岁,开展临床调查并分别于孕12 ～24周,孕28 ～32周,孕36 ～40周采集血液样本,检测基因型,HBsAg、HBeAg、HBVDNA、HBV RNA,肝功能,包括:丙氨酸转氨酶(ALT),天冬氨酸转氨酶(AST),总胆红素(TBiL),总胆汁酸(TBA),胆碱酯酶(CHE),碱性磷酸酶(ALP).数据采用连续变量以x±s;分类变量以率进行统计分析.结果 75例孕妇中B基因型48例(48/75,64.0％),C基因型27例(27/75,36.0％),未发现其他基因型.替诺福韦组和替比夫定组在人口统计学和临床特征方面差异无统计学意义,肝功能检查:替诺福韦治疗前:ALT 21(9 ～362) U/L,AST 25 (14 ～346) U/L,TBiL 8.2 (3.8 ～57.6)μmol/L,ALP78.4 (31.0～232.5) U/L,TBA 3.7 (0.8～45.2) μmol/L;治疗结束时:ALT 21(9 ～98),AST25 (15～102),TBiL8.8 (3.2～17.1)μmol/L,ALP 148.05 (54.0～470.6),TBA3.1(0.9～74.8).替比夫定组治疗前:ALT23(7 ～ 117) U/L,AST 23(16 ～ 62) U/L,TBiL 7.8(5.5 ～ 18.3),ALP 67.4(46.1 ～388.2) U/L,TBA 3.2(1.1 ～ 42.6)μmol/L;治疗结束时:ALT 21(8～62) U/L,AST 24(12 ～161) U/L,TBiL7.3(3.5～18.4) μmol/L,ALP 162.4 (47.3 ～424.0) U/L,TBA 3.8 (0.7～28.4)μmol/L.log10HBV DNA和log10 HBV RNA,替诺福韦组治疗前:HBV DNA (4.8±2.0),HBV RNA(6.4±1.1);治疗4周时:HBV DNA(4.0±0.8),HBV RNA (6.0±0.9);治疗结束时:HBV DNA(3.1±0.7),HBV RNA (5.5±0.8).替比夫定组治疗前:HBV DNA (5.1±2.0),HBV RNA(6.5±0.9);治疗4周时:HBV DNA (4.4±1.2),HBV RNA(6.5±0.8);治疗结束时:HBV DNA (3.5±1.2),HBV RNA(6.1±0.7),替诺福韦与替比夫定组在治疗结束时,log10HBV DNA和log10HBV RNA显著低于治疗前(孕12 ～24周)(均P＜0.05).在排除其他变量的影响下,基因型对HBV RNA载量有一定的影响,表现在C基因组的患者HBV RNA在治疗结束时比B基因组的患者少下降了0.54个单位(log10),P＜0.05.结论 贵州地区乙肝孕妇以B、C基因型为主,在不同的基因型孕妇使用核苷酸类似物治疗时,B基因型病毒更容易得到控制.

abstractsObjective To investigate whether HBV genotype influences HBV DNA and RNA responses to tenofovir (TDF) and telbivudine (LDT) in pregnant women with HBeAg-positive in Guizhou.Methods This was a retrospective analysis of 75 pregnant women hepatitis B with HBsAg and HBeAg double-positive(19-38 years old,median age 26 years old),who were enrolled in the Department of Infectious Diseases and Obstetrics Clinic of the Affiliated Hospital of Guizhou Medical University from May 2016 to July 2017.Blood samples were collected at 12-24,28-32 and 36-40 weeks of pregnancy for analyses of genotype,including hepatitis B surface antigen (HBsAg),hepatitis B e antigen (HBeAg),HBV DNA,HBV RNA and liver function,alanine transaminase (ALT),aspartate transaminase (AST),total bilirubin(TBiL),total bile acids (TBA),cholinesterase (CHE),alkaline phosphatase (ALP).Continuous variable was adopted by means of mean ± standard deviation,and categorical variables were used for statistical analysis.Results The HBV genotype was B in 64.0％ (48/75) and C in 36.0％ (27/75).The TDF and LDT groups showed no differences in demographic and clinical characteristics,including liver function tests,HBsAg,HBeAg,log10HBV DNA and log10HBV RNA.TDF groups,pre-treatment:HBV DNA (4.8±2.0),HBV RNA (6.4± 1.1);at 4 weeks of treatment:HBV DNA (4.0±0.8),HBV RNA (6.0 ± 0.9);at the end of treatment:HBV DNA (3.1 ± 0.7),HBV RNA (5.5 ± 0.8).LDT groups,pretreatment HBV DNA (5.1 ± 2.0),HBV RNA(6.5 ±0.9);at 4 weeks of treatment:HBV DNA (4.4 ±1.2),HBV RNA(6.5 ±0.8);at the end of treatment:HBV DNA(3.5 ± 1.2),HBV RNA (6.1 ±0.7).Compared with pre-treatment (12-24 weeks),the TDF and LDT group showed significant reductions in log10 (HBV DNA) and log10 (HBV RNA) at 36-40 weeks (P ＜ 0.05).Under the influence of excluding other variables,the genotype had a certain influence on the HBV RNA load.That was,HBV RNA in patients with the C genome decreased by 0.54 units(log10) at the end of the treatment compared to patients with the B genome,and the P value was less than 0.05.Conclusion B and C genotypes are predominant in pregnant women with hepatitis B in Guizhou Province.B-type viruses are more easily controlled when different genotypes are treated with nucleotide analogues.