拉米夫定治疗慢性乙型肝炎YMDD变异的产生与病毒载量的关系  

Study on the relationship between emergence of hepatitis B virus YMDD motif mutants against lamivudine therapy for chronic hepatitis B and serum viral load

作　　者：商庆华[1] 于建国[1] 肖德明[2] 安永[1] 徐传镇[1] 杜庆岭[1] 张光曙[1] 

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]泰安市中心医院

出　　处：《中华检验医学杂志》2005年第9期928-931,共4页Chinese Journal of Laboratory Medicine

摘　　要：目的观察拉米夫定治疗慢性乙型肝炎(CHB)YMDD变异的产生与血清病毒载量的关系。方法选择应用拉米夫定治疗并产生YMDD变异的CHB患者53例,分析血清病毒载量水平与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53例(1∶1配对)对比分析治疗前血清HBVDNA定量水平。结果YMDD变异组治疗前血清HBVDNA定量水平显著高于未产生YMDD变异组(P<0.01)。YMDD变异类型与血清HBVDNA定量水平不相关(P>0.05),但YMDD变异产生时间与血清HBVDNA定量水平相关(P<0.05)。结论CHB患者血清病毒载量水平越高,应用拉米夫定治疗越容易产生YMDD变异,且产生时间越早。血清病毒载量可作为应用拉米夫定治疗YMDD变异产生的早期预测指标。YMDD变异类型与病毒载量不相关。Objective To observe the relationship between emergence of hepatitis B virus （HBV） tyrosine-methionine-aspartate-aspartate （YMDD） motif mutants against lamivudine therapy for chronic hepatitis B （CHB） and serum viral load. Methods One hundred and six CHB patients treated with lamivudine for more than 1 year were enrolled in the study. Among them, 53 patients with and without YMDD motif mutants against lamivudine respectively were comparable in age, sex, liver lesions and so on and positive in serum HBeAg and HBV DNA. The relationship between types and emergence times of YMDD motif mutants and viral load from patients with YMDD motif mutants were analysed comparatively. Meanwhile, the serum HBV DNA level in pretreatment patients with and without YMDD motif mutants were compared. Results The serum HBV DNA level （ logarithmic value） in pretreatment patients with YMDD motif mutants （6.85 ±2.21 copy/ml） were higher significantly than those of patients without YMDD motif mutants（5.37 ± 1.74 copy/ml,P 〈0. O1 ）. There were no significant difference between serum HBV DNA level and distribution of types of YMDD motif mutants （ cases of YVDD, YIDD, YV/IDD in 10, 28, 15 patients with 10^2-10^5 , 10^6-10^8 , 〉 10^8 copy/ml serum HBV DNA, respectively：6,2,2 vs. 15,9,4 vs. 10,3, 2,P 〉 0. 05 ）. On the contrary, emergence times of YMDD motif mutants were shorter and shorter with the increase in serum HBV DNA level, which had statistical significance （emergence times of YMDD motif mutants in 10, 28, 15 patients with 10^2-10^5, 10^6-10^8, 〉 10^8 copy/ml serum HBV DNA, respectively： 13.42±2.68, 10.71 ±1.55, 8.53 ±2.38 months,P〈0. 05）.Condusion The higher serum HBV DNA level form CHB patients were , the easier and earlier emergence of YMDD motif mutants against lamivudine were. Serum HBV viral load can be regarded as an effective early predictive factor of emergence of YMDD motif mutants against lamivudine therapy for CHB. There were no relationship between serum HBV viral load and t

关 键 词：肝炎 乙型 慢性 DNA突变分析 拉米夫定 病毒载量 YMDD变异 拉米夫定治疗 慢性乙型肝炎 HBV-DNA定量 HBVDNA定量 变异类型 

分 类 号：R512.62[医药卫生—内科学] R512.91[医药卫生—临床医学]