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目的观察中医阴虚体质与HBeAg阳性慢性乙型肝炎(chronic hepatitis B,CHB)患者聚乙二醇干扰素α(Peg-IFNα)治疗应答及人类白细胞抗原(HLA)DQA1基因多态性的关系,探讨中医体质因素在干扰素治疗应答中的作用。方法收集行Peg-IFNα治疗的120例HBeAg阳性CHB患者资料,通过体质分类判定中医体质类型后分为阴虚质组(59例)和非阴虚质组(61例)。两组均应用Peg-IFNα-2b(1.0μg/kg体重)或Peg-IFNα-2a(180μg)皮下注射,每周1次;6个月后获得完全应答(CR)或部分应答(PR)初步判断为治疗有效,有治疗应答者完成1年疗程。采用聚合酶链反应序列特异性引物法(PCR-SSP)检测HLADQA1基因型。比较不同应答情况患者体质类型分布及组间基因频率的差异。结果不同体质类型CHB患者Peg-IFNα治疗应答存在差异,阴虚质组有效率[61.0%(36/59)]明显低于非阴虚质组[78.7%(48/61)],差异有统计学意义(P<0.05)。CR患者HLA-DQA1*0501等位基因频率为14.8%(8/54),明显低于无应答(NR)患者的30.6%(22/72);HLA-DQA1*0601等位基因频率为18.5%(10/54)则高于NR患者的5.6%(4/72),差异均有统计学意义(P<0.05)。阴虚质患者HLA-DQA1*0301等位基因频率[2.5%(3/118)]低于非阴虚质患者[9.8%(12/122)],而HLA-DQA1*0501等位基因频率[33.9%(40/118)]高于非阴虚质组患者[18.9%(23/122)],差异均有统计学意义(P<0.05),但校正后差异无统计学意义(P_c>0.05)。结论中医体质和HLA-DQA1基因多态性影响HBeAg阳性CHB患者对Peg-IFNα的应答,阴虚体质和HLA-DQA1*0501基因型不利于应答,但其关系尚有待明确。
Objective To observe the relationship between the treatment of peginterferon α (Peg-IFNα) and the polymorphism of human leukocyte antigen (HLA) DQA1 in patients with HBeAg-positive chronic hepatitis B (CHB) To explore the role of TCM constitutional factors in interferon therapy response. Methods The data of 120 patients with HBeAg positive CHB treated with Peg-IFNα were collected and divided into the yin deficiency group (n = 59) and the non-yin deficiency group (n = 61) by physical classification to determine the TCM constitution type. Both groups received subcutaneous injection of Peg-IFNα-2b (1.0 μg / kg body weight) or Peg-IFNα-2a (180 μg) once a week; initial complete response (CR) or partial response (PR) Judged as effective treatment, treatment response completed 1 year course of treatment. HLADQA1 genotypes were detected by polymerase chain reaction sequence specific primers (PCR-SSP). The differences in the distribution of constitutional types and the frequency of genotypes in patients with different responses were compared. Results Peg-IFNα treatment response was different in patients with different types of CHB. The effective rate in the Yin deficiency group [61.0% (36/59)] was significantly lower than that in the non-Yin deficiency group [78.7% (48/61)], with statistical difference Significance (P <0.05). The frequency of HLA-DQA1 * 0501 allele in CR patients was 14.8% (8/54), significantly lower than that in non-responders (NR) patients (30.6%, 22/72) (10/54) was higher than that of NR patients (5.6%, 4/72), the differences were statistically significant (P <0.05). HLA-DQA1 * 0301 allele frequency (2.5% (3/118)] was lower than that in non-yin deficiency patients [9.8% (12/122)], while allele frequencies of HLA- 33.9% (40/118)] were higher than those in non-yin deficiency group [18.9% (23/122)], the differences were statistically significant (P <0.05), but there was no significant difference after correction ). Conclusion The TCM constitution and HLA-DQA1 gene polymorphism affect the response to Peg-IFNα in HBeAg-positive CHB patients. The relationship between the deficiency of Yin constitution and HLA-DQA1 * 0501 genotype is unfavorable to the response. However, the relationship remains unclear.