江苏徐州地区1954例慢性乙型肝炎患者血清HBV耐药突变分析  

Nucleos(t) ide analog resistance mutation analysis in serum of 1 954 chronic hepatitis B patients in Xuzhou area

作　　者：丁芹[1] 赵玉宝[1] 潘玉[1] 张言超[1] 

机构地区：[1]徐州医学院附属医院感染性疾病科,江苏徐州221002

出　　处：《中西医结合肝病杂志》2013年第5期291-293,共3页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

基　　金：江苏省高校自然科学基础研究面上项目(No.08KJD320012)

摘　　要：目的:探讨江苏徐州地区HBV耐药基因突变分布特征及在评价抗病毒药物疗效中的作用。方法:2010年8月至2013年5月在徐州医学院附属医院就诊的门诊及住院慢性乙型肝炎(CHB)患者血清标本共1 954份,采用核酸扩增技术结合荧光标记探针杂交方法检测血清HBV DNA,通过测序分析进行耐药突变的检测。结果:1 954份标本共检测到病毒变异1 079例,无变异875例,变异率55.22%。检测到变异频次2 114例次,其中同一个位点变异≥5例的例次共有2 036例次。变异率较高的位点有204位点(25.75%)、180位点(17.71%)、181位点(11.62%),其中204+180位突变335例次(17.14%)。拉米夫定相关变异1 411例次(72.21%),阿德福韦酯相关变异873例次(44.68%),替比夫定耐药相关的204位点Ⅰ变异294例次(15.05%),恩替卡韦耐药必需的180M+204V或者180M+204V/I共204例次(10.44%)。未检出替诺福韦酯主要耐药位点rtA194T。结论:拉米夫定、阿德福韦酯耐药变异率相对较高,替比夫定、恩替卡韦经典耐药发生率相对较低,尚未发现替诺福韦酯耐药。Objective： To analyze the distributional characteristics of serum hepatitis B virus nucleoside analog resistance mutation of chronic hepatitis B patients in Xuzhou area. Methods： One thousand nine hundred fifty-four cases chronic hepatitis B patients with positive HBV DNA from Xuzhou area were collected and analyzed according to the clinical data. Results： Resistance mutation were found in 1 079 of 1 954 patients, mutation rate was 55.22%. Two thousand one hundred fourteen mutations were found, of which more than 5 times mutations were 2 036, with the highest mutation rates at site 204 （25.75%）, site 180 （ 17. 71% ） and site 181 （ 11.62% ） . In all mutations, lamivudine related were 1 411 （72. 1% ）, adefovir dipivoxil related were 873 （44. 68% ）, telbivudine related rtM204I were 294 （ 15.05% ） . Total 180 ＋204 mutations were 335 （ 17. 17% ）, in which entecavir related rtL180M ＋ rtM204V and rtL180M ＋ rtM204I/V was 204 （ 10. 44% ） . Tenofovir related rtA194T was not found. Conclusion： Lamivudine and adefovir dipivoxil resistance mutations were more common than telbivudine and entecavir. No tenofovir resistance mutation was found.

关 键 词：肝炎  乙型 慢性 肝炎病毒  乙型 耐药 突变 

分 类 号：R512.62[医药卫生—内科学]