We found that the proportion of men did not differ between the group of patients with virological response and the group without virological response (p 0.05) (Table 3.25). This result is similar to some authors in the world [161]. Univariate logistic regression analysis did not show any association between men and virological response, biochemical response and HBeAg serological response after 12 months of ETV or TDF treatment with p 0.05 (Table 3.29, Table 3.31 and Table 3.33). However, in multivariate logistic regression analysis, there was an association between men and virological response after 12 months of ETV or TDF treatment with OR=3.7; 95%CI: 1.3-10.9 and p=0.02 (Table 3.29).
The mean age of patients with virological response was 42.7 ± 12.7 years, higher than that of patients without virological response was 38.4 ± 13.6 years with p=0.046 (Table 3.25). The study by author Wong GLH (2013) found that the age of patients with virological response after 12 months of ETV treatment was higher than that of patients without virological response, respectively 52 ± 11 (years) compared to 49 ± 12 (years) with p=0.02 [161] and the study by Chon YE (2011) also found that the age of patients with virological response after 12 months of ETV treatment was higher than that of patients without virological response (p=0.865) and the proportion of men was also not different (p=0.973) [41]. Univariate analysis showed that age was not associated with virological response, biochemical response and HBeAg seroconversion after 12 months of treatment with p 0.05 (Table 3.29, Table 3.31 and Table 3.33). This result is similar to that of Lee MH (Korea - 2011), Lee JM (Korea - 2011), Luo J (China - 2013) and Wong GLH (Hong Kong - 2013) who found that in univariate analysis, age and male sex were not associated with virological response [90],[91],[106],[161] and HBeAg seroconversion after 12 months of ETV treatment (p 0.05) [91].
4.4. Limitations of the topic
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The research topic on 202 patients diagnosed with chronic hepatitis B virus and treated with antiviral drugs at the Department of Infectious Diseases - Bach Mai Hospital has met the 3 research objectives of the topic. However, the topic was conducted at the final hospital of the Northern region, so when coming to the hospital, the majority of patients were seriously ill from other levels or patients from provinces and cities around Hanoi or patients with conditions from provinces and cities coming for examination and treatment, so the data on epidemiological characteristics are only meaningful in the research population, not meaningful in the community and not representative of the community.
CONCLUDE
Studying 202 patients diagnosed with chronic hepatitis B and treated with antiviral drugs at the Department of Infectious Diseases - Bach Mai Hospital from August 2010 to February 2014, we have the following conclusions:
1. Epidemiological and molecular biological characteristics
Patients were distributed in many ages with different occupations, the average age was 39.6 ± 13.9 years old, male accounted for 63.8%. The time from the time of detection of HBV infection to medical examination was mostly within 5 years (74.3%), of which 43.6% of patients detected from 6 - 12 months. The vast majority (98.5%) of patients detected HBV infection when they were over 16 years old. A significant proportion of epidemiological factors of HBV infection in the family were detected (mother was 30.9% and siblings were 53.5%).
Two main genotypes were detected, genotype B and genotype C, of which genotype B accounted for the majority (73.6%). HBV strains with mutations in the PC/BCP region accounted for a high proportion (69.5%) with PC G1896A, BCP A1762T, BCP G1764A mutations accounting for 29.8%; 47.9% and 44.6%, respectively. PC G1896A mutations were higher in genotype B than in genotype C, whereas BCP A1762T, BCP G1764A mutations were higher in genotype C than in genotype B. There was a positive correlation between PC/BCP mutations and age and HBeAg-negative status. The study results did not detect drug-resistant mutations M204I/V, I169T, V173L, L180M, A181T/V, T184G, S202I/G, N236T and M250V in
natural HBV strains as well as HBV strains after 12 months of ETV or TDF treatment. The mean HBV-DNA load of patients was 6.4 ± 1.5 log 10 IU/ml, mainly at 5 - <8 log 10 IU/ml (64.4%).
2. Clinical and paraclinical characteristics
Most patients do not have typical clinical symptoms, in which specific symptoms for hepatitis account for a very low percentage (jaundice, yellow eyes: 10.4%; enlarged liver: 2%; yellow urine: 35.7%). Clinical symptoms do not correspond to the severity.
ALT and HBV-DNA load increased, 22.8% of patients had biochemical flare with ALT increased above 5 ULN.
There was no difference in clinical and paraclinical symptoms (biochemistry, hematology, HBeAg and anti-HBe) between genotypes B and C. The level of increased ALT, positive HBeAg and HBV-DNA was higher in the younger age group.
3. Some factors affecting the effectiveness of antiviral drugs.
Factors that influence the treatment effectiveness in terms of virological response after 12 months include: low HBV-DNA load, negative HBeAg and positive anti-HBe before treatment. No factors affecting the treatment effectiveness in terms of serological response were detected in patients with positive HBeAg. Factors affecting the increase in biochemical response were low HBV-DNA load before treatment.
RECOMMENDATION
1. There needs to be a plan to detect people infected with HBV early so that they can be managed, cared for, treated and monitored periodically.
2. It is necessary to check the HBV infection status of the patient's family members to detect early other family members infected with HBV for timely management, monitoring and treatment.
3. Patients with chronic hepatitis B treated with NA antiviral drugs (ETV or TDF) need to have their HBV-DNA load tested and when there is a viral outbreak, drug resistance mutations with the antiviral drugs being used need to be identified to adjust the appropriate drugs.
LIST OF PUBLISHED RESEARCH WORKS RELATED TO THE THESIS TOPIC
1. Nguyen Van Dung, Bui Thi Lan Anh, Nguyen Thuy Linh, Trinh Thi Ngoc, Nguyen Thi Lan Anh (2013), "Study on mutations in the precore/core gene region of HBV virus in patients with chronic hepatitis B virus at Bach Mai hospital", Journal of Preventive Medicine , Volume XXIII, No. 7 (143), pages 19 - 25.
2. Nguyen Van Dung, Bui Thi Lan Anh, Nguyen Thuy Linh, Do Thi Diem Trinh, Do Huy Duong, Trinh Thi Ngoc, Nguyen Thi Lan Anh (2014), "Clinical and paraclinical epidemiological characteristics of patients with chronic hepatitis B treated at Bach Mai hospital", Preventive Medicine Journal , Volume XXIV, No. 8(153), pages 134 - 142.
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ENGLISH
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