拉米夫定耐药慢性乙型肝炎患者HBVP区基因突变模式与基因型的关系  

The mutation patterns of HBV P gene and genotyping in patients with lanivudine.resistant chronic hepatitis B

作　　者：汤佳良 周建康[2] 

机构地区：[1]绍兴市斗门人民医院,312071 [2]绍兴市第六人民医院

出　　处：《中华实验和临床病毒学杂志》2011年第5期342-344,共3页Chinese Journal of Experimental and Clinical Virology

摘　　要：目的分析慢性乙型肝炎患者在拉米夫定（LAM）治疗过程中出现耐药后，HBVP区基因突变模式及基因分型的关系。方法对2008年9月至2010年6月在我院就诊的107例临床诊断为LAM耐药慢性乙型肝炎患者进行HBVP区及基因分型测定。结果107例患者的基因突变模式为8种，100％均发生YMDD序列突变，其中单位点突变43例，其余均为联合突变；107例患者主要以B（25．2％）和C（73．8％）基因为优势，1例为B和c混合基因，且c基因以rtM204＋rtL180M模式为主，占60．7％（48／79），B基因以rtM204突变模式为主，占66．7％（18／27）；rtM204和rtM204＋rtL180M突变模式的B和C基因比较两者差异有统计学意义（x2分别为8．4和7．2，P〈0．01）。结论YMDD基序突变是LAM耐药后HBVP区基因突变的主要模式，不同基因型决定了与耐药相关的变异出现形式。Objective To analyze the mutation patters of HBV P gene and genotyping of heptitis B virus in patients with chronic hepatitis B （CHB） after the emergence of drug-resistance during lamivudine （LAM）therapy. Methods LAM-resistant mutations and genotype of HBV were dectected in patients with LAM-resistant CHB in our hospital from Sep. 2008 to June. 2010. Result 107 patients had 8 mutation patterns. YMDD mutations happened in 100% , only YMDDmutation were 43 patients, while others were YMDD combined with rtL180M mutations; the HBV genotype among 107chronic hepatitis was mainly B （25.2%） and C （73.8%） and only 1 patient was happend B and C mixed infection. Genetype C was mainly YMDD combined with rtL180M mutations pattern, the rate is 60. 7% （48/79） ;while genetype B was mainly rtM204 mutation pattern, the rate is 66. 7% （18/27） ; there were significant difference between the genetype B and C in mutation pattern（x2 = 8.4,7.2,respectively, P 〈 0. 01 ）. Conclusion YMDD mutation is the major mutation pattern of HBV P gene after emergence of LAM-resistanee. Genotypes of hepatitis B virus can determine the related mulation patterns of HBV P gene.

关 键 词：肝炎 乙型 慢性 拉米夫定 药物耐受 病毒 突变 基因分型 

分 类 号：R512.62[医药卫生—内科学]