血清HBV-DNA定量水平与拉米夫定抗HBV感染中YMDD变异的相关性研究  

Study on the Relationship between the Serum HBV DNA Level and the Emergence of Hepatitis B Virus YMDD Motif Mutants during the Therapy of Lamivudine against Chronic Hepatitis B

作　　者：商庆华[1] 于建国[1] 肖德明[2] 徐传镇[1] 杜庆岭[1] 康松华 

机构地区：[1]解放军第88医院济南军区肝病研究所,山东泰安271000 [2]山东省泰安市中心医院,山东泰安271000 [3]河南省社旗县中医院,河南社旗473300

出　　处：《临床军医杂志》2004年第6期1-4,共4页Clinical Journal of Medical Officers

摘　　要：观察拉米夫定治疗慢性乙型肝炎 (CHB)YMDD变异的产生与血清HBV DNA水平的关系。方法　选择应用拉米夫定治疗并产生YMDD变异的CHB患者 5 3例 ,分析血清HBV DNA水平与YMDD变异类型、产生时间的关系。另选择具有可比性的应用拉米夫定治疗但并未产生YMDD变异的CHB患者 5 3例 (1:1配对 )对比分析治疗前血清HBV DNA定量水平。结果　YMDD变异组治疗前血清HBV DNA定量水平显著高于未产生YMDD变异组 (P <0 .0 1)。YMDD变异类型与血清HBV DNA定量水平不相关 (P >0 .0 5 ) ,但YMDD变异产生时间与血清HBV DNA定量水平相关 (P <0 .0 5 )。结论　CHB患者血清HBV DNA水平越高 ,应用拉米夫定治疗越容易产生YMDD变异 ,且产生时间越早。血清HBV DNA水平可作为应用拉米夫定治疗YMDD变异产生的早期预测指标。YMDD变异类型与血清HBV DNA水平不相关。Objective To observe the relationship between the serum HBV DNA level and the emergence of YMDD motif mutants during the therapy of lamivudine against chronic hepatitis B (CHB). Methods One hundred and six CHB patients treated with lamivudine for more than one year were enrolled in the study. Among them, there were respectively 53 patients with and 53 ones without YMDD motif mutant during the therapy of lamivudine. The former 53 patients were analyzed on the relationship between the serum HBV DNA level and the YMDD mutant sort or the time at which it came into being. The HBV DNA levels of the latter 53 ones before therapy were analyzed and compared with that of the former 53 ones (1:1 match).Results The serum HBV DNA level (logarithmic value) before therapy was significantly higher in the patients with YMDD motif mutans (6.85±2.2l copy/ml) than in those without YMDD motif mutants (5.37±1.74 copy/ml) (P<0.01). There were no significant difference between the serum HBV DNA level and the distribution of YMDD motif mutant sort (P>0.05), but the time at which the mutant came into being was correlative to the serum HBV DNA level (P<0.05). Conclusion The higher the CHB patient's serum HBV DNA level is, the easier and earlier the YMDD mutant comes into being if lamivudine is administered. The level of Serum HBV DNA can be regarded as an early predictive index that YMDD motif mutant may emerge during the therapy of lamivudine for CHB. There is no relationship between the serum HBV DNA level and the sort of YMDD motif mutant.

关 键 词：慢性乙型肝炎 YMDD变异 拉米夫定 HBV-DNA定量 

分 类 号：R512.6[医药卫生—内科学]