丙型肝炎病毒基因1b型NS5A耐药基因相关变异及相关因素分析  

Analysis of genotype lb hepatitis C virus NS5A resistance-associated variants and its related factors

作　　者：宁会彬 靳慧鸣 肖二辉[1] 刘俊平[1] 尚佳[1] 

机构地区：[1]河南省人民医院感染科,郑州450003

出　　处：《中华传染病杂志》2017年第12期730-733,共4页Chinese Journal of Infectious Diseases

基　　金：河南省医学科技攻关计划项目（201503171）

摘　　要：目的对HCV基因1b型（HCV GT1b）NS5A耐药基因相关变异（resistance-associated variants，RAV）情况及其与病毒等因素的相关性分析，为丙肝直接抗病毒药物（direct-acting antivirals，DAA）的应用选择提供参考。 方法以河南省人民医院感染科2017年1月至2017年7月收治的53例丙型肝炎患者为研究对象。分析其中43例HCV GT1b患者NS5A RAV中L31M和Y93H的突变发生情况及其与HCV、肝功能、血小板计数及肝纤维化无创诊断模型[丙氨酸转氨酶/血小板计数模型（APRI），γ-GT/血小板计数模型（GPR），基于4项因素的肝纤维化指数模型（FIb-4）]等数据的相关性。定量资料的比较采用两独立样本t检验，定性资料的比较采用χ2检验。 结果共纳入研究对象53例，其中GT1b 43例，男9例，女34例；GT2a 10例，男2例，女8例；未检测出其他基因型。43例HCV GT1b患者NS5A RAV发生率为13.9%（6/43），其中L31M和Y93H分别为1/43（2.3%）、5/43（11.6%），比较差异无统计学意义（χ2＝1.500，P＝0.219）。突变与未突变两组在HCV RNA、ALT、AST、白蛋白、血小板计数及肝纤维化无创诊断模型APRI、GPR、FIb-4等方面差异均无统计学意义（均P〉0.05）。 结论HCV GT1b患者存在NS5A RAV突变且发生率高，不受病毒、血生物化学及肝纤维化等因素影响，HCV治疗前检测NS5A RAV有助于合理选择DAA，减少耐药发生。ObjectiveTo analyze hepatitis C virus genotype （HCV GT）1b NS5A resistance-associated variants （RAV） and its related factors, and to provide references for direct-acting antivirals （DAA） agent selection and application. MethodsFrom January 2017 to July 2017, 53 hepatitis C patients were selected from the Department of Infectious Diseases of Henan Province People＇s Hospital. The mutations of L31M and Y93H in NS5A RAV were analyzed in 43 HCV GT1b patients, and their correlations with hepatitis C virus, liver function, platelet and liver fibrosis diagnostic model [APRI, gamma-glutamyl transpeptidase to platelet ratio （GPR）, FIb-4] were analyzed. The quantitative data were compared by two independent samples t test, and the qualitative data were compared by chi square test. ResultsFifty-three subjects were enrolled, including 43 GT1b （9 males and 34 females） and 10 GT2a （2 males and 8 females）. No other genotype was detected. The incidence of NS5A RAV in 43 HCV GT1b patients was 13.9% （6/43）, of which L31M and Y93H were 1/43 （2.3%） and 5/43 （11.6%） with no significant difference （χ2=1.500, P=0.219）. There were no significant differences in HCV RNA, ALT, AST, albumin, platelets and age between patients with or without mutation （all P〉0.05）. ConclusionsThe incidence of NS5A RAV in HCV GT1b patients is high, but not affected by virus, biochemical factors and liver fibrosis. The detection of NS5A RAV before HCV treatment is helpful for rational selection of DAA, which could reduce the drug resistance.

关 键 词：肝炎病毒属 突变 耐药相关变异 

分 类 号：R512.63[医药卫生—内科学]