慢性乙型肝炎患者HBV基因型分析及对6种核苷类药物的耐药性  

Analysis of genotyping and 6 nucleosides’ resistance of HBV in patients with chronic hepatitis B

作　　者：高万芹[1] 张勤[1] 朱琳 吴斌[2] 何文涛[2] 张庭禄 赵长新[4] GAO Wanqin;ZHANG Qin;ZHU Lin;WU Bin;HE Wentao;ZHANG Tinglu;ZHAO Changxin(Department of Clinical Laboratory,the Fourth People's Hospital of Lianyungang,Lianyungang 222002,Jiangsu,China;Department of Liver Diseases,the Fourth People's Hospital of Lianyungang,Lianyungang 222002,Jiangsu,China;Emergency Office,Lianyungang Disease Control and Prevention Center,Lianyungang 222002,Jiangsu,China;Department of Clinical Laboratory,the Second People's Hospital of Lianyungang,Lianyungang 222002,Jiangsu,China)

机构地区：[1]连云港市第四人民医院医学检验科,江苏连云港222002 [2]连云港市第四人民医院肝病科,江苏连云港222002 [3]连云港市疾病与预防控制中心应急办公室,江苏连云港222002 [4]连云港市第二人民医院医学检验科,江苏连云港222002

出　　处：《检验医学》2019年第11期994-997,共4页Laboratory Medicine

摘　　要：目的探讨本地区慢性乙型肝炎(CHB)患者乙型肝炎病毒(HBV)基因型分布特点、耐药基因变异及对6种核苷类药物的耐药情况。方法采用实时荧光定量聚合酶链反应(PCR)、巢式PCR和Sanger测序法检测82例CHB患者HBV DNA、HBV耐药基因(HBV P区基因特异性片段)和HBV P区基因耐药相关位点突变,同时检测丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、乙型肝炎e抗原(HBeAg)、乙型肝炎e抗体(HBeAb)。结果82例CHB患者中检出B型HBV 25例(30.5%)、C型HBV 51例(62.2%)、B+C混合型HBV 5例(6.1%)、未分型1例(1.2%)。B型CHB患者与C型CHB患者之间血清ALT水平、血清AST水平、血清HBV DNA载量及HBeAg、HBeAb阳性率差异均无统计学意义(P>0.05)。阿德福韦酯、替诺福韦酯的敏感率最高,均为64.63%。恩替卡韦敏感性下降者占34.15%。替比夫定耐药率为53.66%,恩曲他滨、拉米夫定耐药率均为50.0%。结论本地区CHB患者HBV基因型以C型为主,B型次之。阿德福韦酯、替诺福韦酯的敏感性较高。Objective To investigate the distribution characteristics of hepatitis B virus(HBV)genotypes,the variation of drug resistance genes and the drug resistance of 6 nucleosides in patients with chronic hepatitis B(CHB).Methods The HBV DNA of 82 CHB patients was determined by real-time fluorescence quantitative polymerase chain reaction(PCR).The detection of HBV drug resistance gene was carried out by nested PCR to amplify the gene fragment of HBV P region.The Sanger sequencing method was used to detect the gene drug resistance site of HBV P region.Alanine aminotransferase(ALT),aspartate aminotransferase(AST),hepatitis B e antigen(HBeAg)and hepatitis B e antibody(HBeAb)were determined.Results Totally,25 cases(30.5%)of HBV type B,51 cases(62.2%)of HBV type C,5 cases(6.1%)of HBV B+C mixed type and 1 case(1.2%)of other type were detected in 82 CHB patients.There was no statistical significance in ALT,AST,HBV DNA load,HBeAg and HBeAb between type B and type C CHB patients(P>0.05).The sensitivities of adefovir dipivoxil and tenofovir dipivoxil were 64.63%,and the decreased sensitivity of entecavir accounted for 34.15%.The resistance rate of telbivudine was 53.66%,those of emtricitabine and lamivudine were 50.0%.Conclusions The main HBV genotypes of 82 patients with CHB are type C and type B. Adefovir dipivoxil and tenofovir dipivoxil have high sensitivities.

关 键 词：乙型肝炎病毒 基因型 基因突变 耐药性 慢性乙型肝炎 

分 类 号：R446.1[医药卫生—诊断学]