慢性乙型肝炎患者治疗前后乙型肝炎病毒YMDD突变情况分析  

Analysis of HBV YMDD mutations in patients with chronic hepatitis B before and after lamivudine therapy

作　　者：彭瑛[1] 邓正华[1] 温先勇[1] 

机构地区：[1]泸州医学院附属医院检验科,四川泸州646000

出　　处：《现代医药卫生》2015年第7期991-992,995,共3页Journal of Modern Medicine & Health

摘　　要：目的：采用Taqman荧光探针技术对慢性乙型肝炎（乙肝）患者血清中乙肝病毒P基因区550位点的突变情况进行检测，对该院慢性乙肝患者乙肝病毒YMDD突变情况进行调查，为指导临床使用拉米夫定对乙肝患者进行治疗提供重要的参考依据。方法2013年2~12月选取HBV DNA定量在2.00E＋03 IU以上的慢性乙肝患者186例，其中90例未经过治疗（未治疗组），96例使用拉米夫定治疗1年以上（治疗组）。其血清采用聚合酶链式反应结合Taqman荧光探针技术，分C、I、V三组，分别对总HBV DNA（包括野生型和突变型DNA），YIDD突变DNA，YVDD突变DNA进行检测。结果186例慢性乙肝患者中发生P基因区变异者共87例，其中治疗组患者发生YIDD变异9例（9.4%），发生YVDD变异36例（37.5%），YIDD和YVDD同时变异6例（6.2%）；未治疗组患者发生YIDD变异6例（6.7%），发生YVDD变异24例（26.7%），YIDD和YVDD同时变异6例（6.7%）。两组患者YIDD变异、YVDD变异及YIDD和YVDD同时变异发生情况比较，差异均无统计学意义（χ2=0.011、0.156、0.206，P〉0.05）。结论经过拉米夫定治疗的患者乙肝病毒P基因区发生变异的频率高，但未经治疗的慢性乙肝患者体内的乙肝病毒也可自然发生P基因区的变异，故在治疗前及治疗中进行耐药基因的检测对指导临床治疗用药具有重要意义。Objective A total of 550 locus mutations of hepatitis B virus in the P gene region was detected by Taqman fluorescent probe among the patients′serum with chronic hepatitis B. A survey on patients with hepatitis B virus YMDD mutations in this hospital were conducted to guide the clinical use of lamivudine and provide an provide an important reference in clinic . Methods It was collected 186 chronic HBV patients from February to December of 2013 ,whose HBV DNA quantification was more than 2.00E＋03 IU,in which,90 patients were deemed as the non—treatment group and 96 as the treatment group with lamivu—dine for over 1 year. These patients′serum was detected by polymerase chain reaction combined with Taqman fluorescent probe and divided into group C,I and V,and detecting their total HBV DNA（the wild—type and mutant DNA）,YIDD mutant DNA and YVDD mutant DNA respectively. Results There were 87 cases with P gene variation among the 186 patients with chronic HBV , in which,9 cases in the treatment group had YIDD variation,accounting for 9.4%,36 cases occurred YVDD variation,accounting for 37.5%,6 with YIDD and YVDD variation,accounting for 6.2%;6 cases in the non—treatment group had YIDD variation,ac—counting for 6.7%,24 cases occurred YVDD variation,accounting for 26.7%,6 with YIDD and YVDD variation,accounting for 6.7%. The variations of YIDD,YVDD and YIDD＆amp;YVDD were compared simultaneously. The difference was statistically signifi—cant（χ2=0.011,0.156,0.206,P〉0.05）. Conclusion The patients treated by lamivudine were of high occurrence of mutations in hepatitis B virus P gene region. The chronic hepatitis B patients without the treatment occurred naturally variation of hepatitis B virus P gene region. Therefore,detecting drug—resistant gene before or during the treatment is important in guiding clinical therapy.

关 键 词：肝炎 乙型 慢性 肝炎病毒 乙型 拉米夫定 DNA 病毒 

分 类 号：R512.62[医药卫生—内科学]