拉米夫定与HBV-YMDD变异关系的研究  

Effect of lamizodine on the variation of HBV-YMDD

作　　者：刘集鸿[1] 曾宏[1] 曹碧红[1] 李旭艳[1] 温帆渊[1] 陈彩贞[2] 

机构地区：[1]惠州市中心人民医院,广东惠州516001 [2]惠州卫生学校,广东惠州516000

出　　处：《中国热带医学》2008年第9期1483-1484,1487,共3页China Tropical Medicine

基　　金：广东惠州市科学技术局(编号:2005Y40)

摘　　要：目的探讨惠州地区慢乙肝(CHB)患者拉米夫定治疗与HBV-YMDD变异的发生和发展的关系。方法选取在肝病专科就诊的176例CHB患者,在服用拉米夫定前及服药后每半年进行HBV-DNA定量及YMDD变异检测,并选取35份发生YMDD变异和10份野生型YMDD血清样本进行DNA测序。结果176例CHB患者样本中,拉米夫定治疗前检出YMDD变异7例(其中YM/YVDD型2例、YVDD型3例、YIDD型2例),变异率3.98%;治疗2年后共检出62例(其中YVDD型9例、YIDD型36例、YM/YVDD混合型9例、YM/YIDD混合型3例、YV/YIDD混合型5例),变异率35.23%。6例CHB患者在拉米夫定治疗过程中其YMDD变异类型会发生改变。结论惠州地区CHB患者经拉米夫定治疗,随着病情发展,变异类型可能会发生改变,YIDD可能是最终的变异类型,YM/YVDD、YVDD和YM/YIDD可能都是过渡的变异类型。Objective To investigate the correlation of lamivodine with the occurrence and development of HBV - YMDD mutation in chronic hepatitis B（CHB） in Huizhou. Methods There 176 patients from the specialized outpatient service in our hospital received lamivodine treatment and HBV - DNA and YMDD mutation were analyzed before and after treatment for six months. DNA were sequenced with 35 serum samples of YADD mutation and 10 serum samples of wild mutation. Results Out of the 176 serum samples, YMDD mutation was observed in 7 samples （2 samples were YM/YVDD, 3 samples were YVDD, 2 samples were YIDD） with a mutation rate of 3.98% ; YMDD mutation were detected in 62 samples a year after treatment （9 samples were YVDD, 36 samples were YIDD, 9 samples were YM/YVDD, 3 samples were YM/YIDD, 5 samples were YM/YVDD） with a mutation ra te of 35.20%. Among 3 patients with YM/YVDD two years after treatment, 2 patients changed to YVDD and a patient changed to YV/YIDD. 2 patients with YVDD were detected a years after treatment, but one patient changed to YIDD and another changed to YV/YIDD two years after treatment. One patient with YVDD was detected with treatment for six months, but changed to YIDD a year after treatment . Conclusion In CHB patients before Lamivodine treatment, the rate of HBV YMDD mutation was 3.98% and 35.20% two years after treatment, the type of mutation may possibly change with development of the disease, YIDD may be the final mutation type, YM/YVDD, YVDD and YM/ YIDD may be interim mutation type. The regularity of change may be YMDD→ YM/YVDD→ YVDD（ YM/YIDD）→YIDD.

关 键 词：拉米夫定 慢性乙型肝炎 乙肝病毒 YMDD变异 

分 类 号：R512.62[医药卫生—内科学]