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目的通过分析人类白细胞抗原-DR(HLA-DR)抗原与抗HBV疗效的相关性,探讨影响拉米夫定治疗慢性乙肝的自身因素。方法观察和比较HBeAg阳性和阴性慢性乙肝各160份全血标本及临床治疗资料,采用PCR-SSP方法检测患者HLA-DR抗原基因位点信息,分析HLA-DR检测的位点信息与拉米夫定服药患者持续病毒应答的相关性。结果 HBeAg阳性的乙肝患者的持续病毒应答能力较差,即在持续服用拉米夫定治疗后均有肝功和病毒复制数的反复;HLA-DR基因分布在服用拉米夫定后的HBeAg阳性和阴性患者中存在差异:HBeAg阳性患者中DR3、7、8、14的基因频率(GF:0.217;0.141;0.045;0.22)明显高于HBeAg阴性患者(GF:0.006;0.038;0.006;0.055)(P<0.01),而HLA-DR4、13的基因频率(GF:0.035;0.029)明显低于HBeAg阴性患者(GF:0.193;0.225)(P<0.01)。结论 HLA-DR3、7可能具有促进HBV持续感染降低拉米夫定疗效作用,而HLA-DR4、13则作用相反,而HLA-DR8、14与抗HBV的相关性有待证明,此研究结果提示了乙肝患者自身因素HLA-DR基因多态性可对乙肝患者个体化治疗方案的确定提供帮助。
OBJECTIVE: To investigate the association between anti-HLA-DR antigen and anti-HBV efficacy in patients with chronic hepatitis B and to explore the factors that affect lamivudine treatment of chronic hepatitis B patients. Methods The data of 160 whole blood samples and clinical treatment of HBeAg-positive and -negative chronic hepatitis B were observed and compared. The site of HLA-DR antigen was detected by PCR-SSP. The location information of HLA-DR was analyzed with that of Lamiv Correlation of persistent viral response in patients taking medication. Results HBeAg-positive patients with chronic hepatitis B virus response ability is poor, that is, after continuous administration of lamivudine have liver function and virus replication number of repetitions; HLA-DR gene distribution after taking lamivudine HBeAg positive (GF: 0.217; 0.141; 0.045; 0.22) in HBeAg-positive patients were significantly higher than those in HBeAg-negative patients (GF: 0.006; 0.038; (GF: 0.035; 0.029) was significantly lower than that of HBeAg negative patients (GF: 0.193; 0.225) (P <0.01). Conclusions HLA-DR3,7 may promote the efficacy of lamivudine in patients with persistent HBV infection, whereas HLA-DR4,13 has the opposite effect. However, the correlation between HLA-DR8,14 and anti-HBV remains to be proved. The results suggest that Hepatitis B patients with HLA-DR gene polymorphism of their own factors in patients with hepatitis B can help determine the individual treatment options.