乙型肝炎病毒基因分型与拉米夫定临床应用反应  

Genotyping of hepatitis B virus and the respond to lamivudine treatment

作　　者：周胜生[1] 王永忠[2] 

机构地区：[1]常州第三人民医院肝病科,213001 [2]常州第三人民医院肝病实验室,213001

出　　处：《肝脏》2004年第2期77-79,共3页Chinese Hepatology

摘　　要：目的　了解常州地区乙型肝炎病毒 (HBV)基因型分布特征 ,探讨基因型与肝功能损害、病毒复制水平及其与拉米夫定疗效关系。方法　 76例慢性乙型病毒性肝炎患者每天口服拉米夫定 10 0mg治疗 ,并于治疗 4～ 6周时测定不同基因型患者的丙氨酸转氨酶 (ALT)和HBVDNA ,治疗 48周后测定HBVDNA反跳和YMDD变异。采用巢式聚合酶链反应 (nestPCR)法扩增HBVS基因区 ,以 4色荧光标记PCR产物末端 ,在以毛细管高压电泳为核心技术的核酸序列分析仪上自动测序 ,将测序结果与基因库中登录的标准基因型序列相比较。结果　 76例慢性乙型肝炎患者血清HBVDNA基因分型示 :B型株感染 2 6例 ( 3 4.2 %) ,C型株感染 5 0例 ( 65 .8%)。B和C基因型患者ALT值分别为 ( 2 46.3± 13 8.8)U和 ( 2 83 .7± 12 5 .6)U ,(t =0 .3 3 5 ,P >0 .0 5 ) ,HBVDNA含量分别为 10 7.1 2 4± 10 1 .49和 10 7.1 89± 10 1 .56拷贝 /ml(t=0 .13 8,P >0 .0 5 ) ,HBeAg阳性数分别为 2 0例和 41例 ( χ2 =0 .15 9,P >0 .0 5 )。拉米夫定治疗 4～ 6周后 ,B基因型和C基因型患者ALT、HBV DNA(阴转 )、HBVDNA(拷贝 /ml)均呈良好恢复状态 ,两组间差异无显著性。治疗 48周后 ,HBVDNA反跳者B基因型 2 0例 ,C基因型 16例 ( χ2 =13 .49,P <0 .0 0 1)。结论　常州地?Objective To study the relationship between genotypes serum HBV DNA level and the respond to lamivudine treatment. Methods Nested PCR was conducted in 76 chronic hepatitis B patients' serum to amplify the gene C region of HBV. The PCR products'ends were labelled with four color fluorescence and automatically analyzed by ABI PRISM 310 nucleic acid sequence analysis equipment, the results of sequence analysis were compared with the standard genotype sequence logged in GenBank. Seventy six patients received lamivudine treatment with 100mg every day.Results Among 76 chronic hepatitis B, 26 samples were genotype B (34.2%), 50 samples were genotype C (65.8%), serum alanine aminotransferase (ALT) value was (246.3±138.8)U in patients with HBV genotype B, and (283.7±125.6)U in genotype C ( t =0.335 P >0.05). HBV DNA value was 10 7.124 ±10 1.49 copies/ml in genotype B and 10 7.189 ±10 1.56 copies/ml in genotype C ( t =0.138, P >0.05), and there were 20 and 41 HBeAg positive cases in patients with genotypes B and C ( χ 2=0.159, P >0.05). Twenty six genotype B and 50 genotype C patients received treatment of lamivudine. After 4 6 weeks' treatment, there were no significant difference in the level of ALT, HBV DNA and the HBV DNA conversion, after 48 weeks, the level of HBV DNA of 20 patients with genotype B and 16 patients with genotype C rebounded ( χ 2=13.49, P <0.001).Conclusion These results indicate that genotype B and C exist in Changzhou area. There are no significant difference in the level of ALT, patients with genotype C is better than that of the patients with genotype B.

关 键 词：乙型肝炎病毒 基因分型 拉米夫定 临床应用 

分 类 号：R512.6[医药卫生—内科学]