拉米夫定治疗后发生YMDD变异的相关因素分析  

The correlations of HBV YMDD mutation in CHB patients who were treated with Lamivudine

作　　者：谢琴秀[1] 许家璋[2] 郜玉峰[1] 李平[2] 杨志国[2] 孟运运[2] 张馨[2] 李旭[1] 

机构地区：[1]安徽医科大学第一附属医院感染科,合肥230032 [2]南京八一医院肝病研究所

出　　处：《中华传染病杂志》2005年第5期314-317,共4页Chinese Journal of Infectious Diseases

摘　　要：目的探讨慢性乙型肝炎(CHB)患者在服用拉米夫定后发生YMDD变异的相关因素。方法用聚合酶链反应(PCR)荧光定量法测定CHB患者治疗前的HBV DNA,用PCR荧光定量法联合溶解曲线法和杂交探针检测YMDD变异,并对其结果进行分析。结果61例CHB患者基因型检测结果为B型27例占44.2%,C型34例占55.7%,其中22例变异者中B型为9例,占40.9%(9/22),C型13例占59.1%(13/22)。30例未变异者中B型为14例占46.7%(14/30),C型为16例占53.3%(16/30)。YMDD变异与基因型无明显相关性(χ2=0.17,P>0.05)。发生YMDD变异的22例患者在12个月和18个月发生变异的HBV DNA水平明显高于未变异组(t=2.33,P<0.05和t=4.19,P<0.01),发生YMDD变异组与未变异组之间在治疗前的血清丙氨酸氨基转移酶(ALT)、HBeAg状态、患者的病程、年龄等方面没有显著性差异。结论HBV YMDD变异与基因型之间无明显相关性;高滴度的HBV DNA(>108拷贝/毫升)是发生YMDD变异的相关因素。Objective To investigate the factors associated with HBV YMDD mutation in CHB patients who were treated with lamivudine. Methods HBV genotypes was detected by using HBV S sequence analysis,the HBV DNA titer and HBV YMDD mutations were detected by using polymerase chain reaction（PCR） ,then we analysed the correlations of HBV YMDD mutation. Results HBV genotyping results showed that HBV genotype B, C accounted for about 44.26% （27/61）and 55.74% （34/61） respectively. There was no significant difference on HBV genotypes（x^2=0.17,P〉0.05）. The titer of HBV DNA is higher in YMDD mutation group than in no mutation group at twelve month or eighteen month with （8.14±0.94）vs （7.29±0.97） and （8.28±0.77） vs （7.17±0.91） respectively. （t=2.33, P〈0.05 and t=4.19, P〈0.01）. There was no significant difference on level of Alanine aminotransferase（ALT）, HBeAg positive and age. Conclusions There is no correlation between YMDD mutation and HBV genotypes and HBV YMDD mutation is correlated with the high level of pretreatment HBV DNA（〉 10^8 copies/ml）.

关 键 词：肝炎病毒 乙型 YMDD变异 DNA 病毒 基因型 拉米夫定 

分 类 号：R512.62[医药卫生—内科学] R395.6[医药卫生—临床医学]