逆转录酶区A181T/V和A181T/V+N236T变异的乙型肝炎病毒感染者临床特征分析  

Clinical characteristics of patients with A181T/ V mutation or A181T/ V+N236T mutation in hepatitis B virus reverse transcriptase region after nucleoside treatment

作　　者：李平[1] 杨志国[1] 张馨[1] 常静霞[1] 高蕾[1] 汪茂荣[1] 

机构地区：[1]解放军第81医院肝病研究所,南京市210002

出　　处：《实用肝脏病杂志》2014年第1期37-40,共4页Journal of Practical Hepatology

基　　金：国家艾滋病和病毒性肝炎等重大传染病防治专项(2008ZX10002-004)

摘　　要：目的比较逆转录酶区A181T/V变异与A181T/V+N236T变异的乙型肝炎病毒感染者临床特征的异同。方法对55例发生rtA181T/V单独变异和34例发生rtA181T/V+rtN236T联合变异的乙型肝炎病毒感染者既往核苷(酸)类似物治疗情况进行回顾,对耐药时谷丙转氨酶、谷草转氨酶、HBV M、HBV DNA等指标进行检测,并根据耐药测序结果确定病毒的基因型。结果阿德福韦单药治疗患者发生A181T/V+N236T变异较A181T/V变异的比例高(57.6%对42.4%,P<0.05),而拉米夫定换用(或加用)阿德福韦治疗患者发生A181T/V变异较A181T/V+N236T变异的比例高(75.5%对24.5%,P<0.05);在89例患者中B基因型和C基因型分别是14例和75例,不同变异在B或C基因型中的分布无统计学差异;A181T/V变异与A181T/V+N236T变异相比,两组患者的年龄、性别构成、谷丙转氨酶、谷草转氨酶、HBV DNA、HBsAg定量、HBeAg状态等指标均无统计学差异。结论不同的核苷(酸)类似物治疗可导致A181T/V变异和A181T/V+N236T变异模式的差异,但这两种变异感染者临床指标无明显差异。Objective To compare the clinical features between patients infected with hepatitis B virus （HBV）presenting A181T/V mutation or A181T/V＋N236T mutation in HBV reverse transcriptase region after nucle-oside treatment. Methods Fifty-five patients with rtA181T/V mutation and 34 patients with rtA181T/V＋rtN236T mutation were enrolled in this study. Their administration of nucleoside analogues was reviewed;Serum ALT, AST,HBV M and HBV DNA were detected;HBV genotypes were determined by DNA sequencing. Results In adefovir treatment group,the A181T/V＋N236T mutation was more common than rtA181T/V mutation（57.6% vs. 42.4%, P〈0.05）,while the occurrence of rtA181T/V mutation was higher than A181T/V＋N236T mutation in patients re-ceiving lamivudine treatment（75.5% vs. 24.5%,P〈0.05）;In the total 89 patients in our series,there were 14 cases with genotypes B and 75 cases with genotype C of HBV infection,and there was no significant difference in the distribution of mutations between patients with either of the two genotype infection; There were no statistical dif-ferences as respect to age,gender,ALT,AST,HBV DNA, HBsAg titers and HBeAg status between the two groups of patients with different mutations. Conclusions A given nucleoside analogue treatment leads to specific pattern of HBV reverse transcriptase region mutation;However,there is no special clinical significance between different mutations.

关 键 词：乙型肝炎 乙型肝炎病毒逆转录酶区 核苷类耐药 变异 

分 类 号：R512.62[医药卫生—内科学]