乙型肝炎病毒基因型临床相关性和治疗的影响

StephenW

Hepatitis B Virus Genotypes: Clinical Relevance and Therapeutic Implications

    Chih-Lin Lin,
    Jia-Horng Kao


Abstract

At least ten hepatitis B virus (HBV) genotypes (A to J) with distinct geographic distributions have been recognized. HBV genotype is not only predictive of clinical outcome but also implicated in responsiveness to antiviral therapy, especially interferon-based regimens. HBV genotype-specific immunologic and virological pathogenesis may contribute to heterogeneous clinical outcomes in chronic hepatitis B patients. For example, patients with genotypes C and D infection have a lower rate of spontaneous HBeAg seroconversion. In addition, genotype C and D have a higher frequency of basal core promoter A1762T/G1764A mutation than genotype A and B. Genotypes C and D also carry a higher risk of cirrhosis and HCC development than genotype A and B. Therapeutically, genotype A and B patients have a better response to interferon-based therapy than genotypes C and D patients, but the response to nucleos(t)ide analogues is comparable across all HBV genotypes. In conclusion, genotyping of HBV can help practicing physicians identify chronic hepatitis B patients who are at risk of disease progression and optimize anti-viral therapy in clinical practice.

StephenW

已确认至少有10个B型肝炎病毒（HBV）基因型（A至J）具有鲜明的地域分布。 HBV基因型不仅是预测临床结果，但也牵连抗病毒治疗，尤其是干扰素为基础的方案的响应。 HBV基因型特异性免疫学和病毒学的发病机制可能有助于异构慢性乙型肝炎患者的临床结果。例如，C和D基因型感染的患者有自发性HBeAg血清转换率较低。此外，C型和D基因型有较高的基本核心启动A1762T/G1764A突变的频率比A和B基因型C和D也有较高风险比A和B基因型治疗肝硬化和肝癌发展，A基因型和乙肝患者有更好的反应比C和D基因型患者干扰素为基础的治疗，但核苷（酸）类似物的反应是在所有HBV基因型相媲美。总之，乙肝病毒基因分型可以帮助执业医师找出慢性乙肝患者在疾病进展风险和优化抗病毒治疗，在临床实践中。