慢性乙型肝炎患者HBV基因分型和耐药突变的分析  

Analysis of HBV genotypes and drug-resistance mutation in patients with chronic hepatitis B

作　　者：李雯 赖启南 张志成[1] 李炜 陈勇平 肖影群[1] LI Wen;LAI Qinan;ZHANG Zhicheng;LI Wei;CHEN Yong;CHEN Chuanying;XIAO Yingqun(The Ninth hospital of Nanchang,Nanchang330002;The People’s hospital of Ningdu,Ningdu Ganzhou JiangXi 342800;The People’s hospital of Yihuang,Yihuang Fuzhou JiangXi 34400)

机构地区：[1]南昌市第九医院,江西南昌330002 [2]宁都县人民医院,江西宁都342800 [3]宜黄县人民医院,江西宜黄344400

出　　处：《实验与检验医学》2019年第6期998-1001,1005,共5页Experimental and Laboratory Medicine

基　　金：江西省科技厅基础研究项目（项目编号：20112BBG70075）

摘　　要：目的利用PCR-反向点杂交(PCR-RDB)技术检测乙型肝炎病毒(HBV)基因分型及耐药位点突变情况,为临床制定抗病毒治疗方案提供参考依据,帮助降低疾病进展风险。方法收集2017年7月至2019年6月南昌市第九医院的542例慢性乙肝患者,采用PCR-RDB法检测HBV基因型和耐药突变位点情况。结果本研究中542例CHB患者,共检出B基因型450例(83.0%,450/542),C基因型68例(12.6%,68/542),检出BC基因型、BD基因型和其他基因型分别为13(2.4%,13/542)、8(1.5%,8/542)、3(0.6%,3/542)。同时,检出184例患者发生耐药突变,耐药检出率为33.9%(184/542),其中B基因型151例,耐药检出率为33.6%(151/450),C基因型22例,耐药检出率为32.4%(22/68),B、C基因型在耐药检出率方面无统计学差异(P>0.05)。分析结果显示,HBV对拉米夫定、替比夫定、阿德福韦酯和恩替卡韦4种药均具有耐药性,发生耐药突变例数分别为152(82.6%)、151(82.1%)、50(27.2%)和27(14.7%),同时检出20种耐药突变模式,单个位点突变以rt204 I/V突变检出率最高(33.7%,62/184),多个位点突变以rt204 I/V+rt180 M突变检出率最高(22.3%,41/184)。结论江西地区慢性乙肝患者HBV基因型主要以B、C基因型为主,核苷(酸)类似物相关HBV耐药突变模式复杂多样,且耐药检出率较高。Objective To detect the genotypes and drug-resistance mutations of hepatitis B virus(HBV)by PCR-RDB technique,so as to provide a reference for clinical antiviral therapy and help reduce the risk of disease progression.Methods A total of 542 patients with chronic hepatitis B from July 2017 to June 2019 in the ninth hospital of Nanchang were collected and HBV genotypes and drug-resistance mutation were detected by PCR-RDB.Results Among the 542 patients with CHB in this study,450 patients(83.0%,450/542)were B genotype,68 patients(12.6%,68/542)were C genotype,13 patients(2.4%,13/542)were BC genotype,8 patients(1.5%,8/542)were BD genotype,and 3 patients(0.6%,3/542)were other genotypes.Meanwhile,184 patients were detected to have drug-resistant mutations,with the drug-resistant detection rate of 33.9%(184/542),including 151 patients with B genotype,33.6%(151/450),23 patients with C genotype,32.4%(22/68),and no statistical difference in the drug-resistant detection rate between B and C genotypes(P>0.05).Analysis results show that HBV was resistant to LAM,LdT,ADV and ETV,resistant detection rates were 152(82.6%),151(82.1%),50(27.2%)and 27(14.7%),respectively.At the same time,check out 20 kinds of drug resistance mutation patterns,the single point mutation rt204I/V being the most common(33.7%,62/184),meanwhile mutation detection rate of the multi-site mutation rt204 I/V+rt180 M is highest(22.3%,41/184).Conclusion HBV genotypes of chronic hepatitis B patients in JiangXi are mainly B genotype and C genotype,and the patterns of NAs-related HBV drug-resistant mutations are complex and diverse,as well as with a high rate of drug-resistant mutations.

关 键 词：HBV 慢性乙型肝炎 基因分型 耐药突变位点 

分 类 号：R512.62[医药卫生—内科学] R373.21[医药卫生—临床医学]