乙型肝炎病毒YMDD变异对临床病情的影响  

The influence of clinical state in YMDD mutation in patients with chronis hepatitis B

作　　者：江水清[1] 朱建芸[2] 崇雨田[2] 陈雪娟[2] 黄仰甦[2] 

机构地区：[1]安徽省淮南市第二矿工医院感染科,232052 [2]中山大学附属第三医院传染病科

出　　处：《实用肝脏病杂志》2004年第4期203-204,210,共3页Journal of Practical Hepatology

摘　　要：目的　研究拉米夫定治疗乙型肝炎出现YMDD变异后对临床病情及病毒量的影响 ,以及YMDD变异与前C区变异的相关性。方法　对 13 5例曾用过拉米夫定治疗后复发的住院病例 ,按检查结果分为两组 ,YMDD变异组 61例 ,未变异组 74例 ,对两组病情诊断、病毒载量、肝功能指标 ,YMDD变异与HBeAg、前C区变异的关系进行对照分析。结果　YMDD变异与未变异在慢性肝炎 (轻度 )分别为 9.8% ( 6/ 61)与 8.1% ( 6/ 74)、慢性肝炎 (中度 )分别为 44 .3 % ( 2 7/ 61)与 48.6% ( 3 6/ 74)、慢性肝炎 (重度 )分别为 2 6.2 % ( 16/ 61)与 2 9.7% ( 2 2 / 74)、慢性重型肝炎分别为 9.8% ( 6/ 61)与 14 .9%( 11/ 74)、肝硬化分别为 4.9% ( 3 / 61)与 10 .8% ( 8/ 74) ,各组比较均无显著性差异 (P >0 .0 5 )。两组病毒载量 <1×10 4copies/ml者分别为 1.6% ( 1/ 16)与 2 0 .3 % ( 15 / 74,P <0 .0 1)、1× 10 4～ 10 6copies/ml者分别为 9.8% ( 6/ 61)与 2 9.7% ( 2 2 /74,P <0 .0 1)、≥ 1× 10 7copies/ml者分别为 88.5 % ( 5 4/ 61)与 5 0 .0 % ( 3 7/ 74,P <0 .0 1)。肝功能 6项指标中ALT、ALB、A/G、TBIL对比无显著性差异 (P >0 .0 5 ) ,AST、PTA对比差异显著 (P <0 .0 5 )。YMDD变异组中HBeAg阳性率 68.9% ( 4 2 / 61) 。ObjectiveTo study the effects of clinical state and relations of YMDD mutation in pre-C mutations after lamivudine therapy in patients with chronic hepatitis B.Methods135 patients with state of illness worsenning after lamivudine therapy were divided into two groups,61 cases with YMDD mutation and 74 cases without YMDD mutation.The diagnosis,HBV DNA level,liver function,HBeAg and pre-C mutations were detected,respectively.ResultsThe rates of slight CHB in YMDD and non YMDD mutation groups were 9.8%(6/61) and 8.1%(6/74),Moderate CHB were 44.3%(27/61)and 48.6%(36/74),Serious CHB were 26.2%(16/61)and 29.7%(22/74),chronic severe hepatitis vere 9.8%(6/61)and 14.9%(11/74),cirrhosis were 4.9%(3/61)and 10.8%(8/74)(P>0.05).HBV DNA level in the two groups under 1×10 4copies/ml were 1.6%(1/61)and 20.3%(15/74,P<0.01),in 10 4～10 6copies/ml were 9.8%(6/61) and 29.7%(22/74,P<0.01),in more than l×10 4copies/ml were 8.5%(54/61) and 50.0%(37/74,P<0.01).The levels of ALT,ALB,A/G and TBIL in two groups were no obvious difference(P>0.05).The AST in YMDD mutation group was higher than those in without YMDD mutation (P<0.05).The PTA in YMDD mutation group was lower than those of other group (P<0.05).The HBeAg positive in YMDD mutation group was 68.9%(42/61),and in other group was 35.1%(26/74,P<0.01).The number of Pre-C mutation in YMDD mutation group was 74.1%(40/54),and in other was 51.6%(32/64,P<0.01).ConclusionThere are few differences between in state of illness and liver functions in YMDD mutation group than without YMDD mutation group.However,HBV DNA level is higher after YMDD mutation.YMDD mutation is accompanying with pre-C mutation frequently.

关 键 词：YMDD变异 前C区变异 病情诊断 慢性肝炎 临床 HBEAG阳性 乙型肝炎病毒 ALT 阳性率 

分 类 号：R512.62[医药卫生—内科学]