乙型肝炎患者不同突变谱的乙肝表面抗原水平变化  

Changes in HBsAg levels in hepatitis B patients with different mutant spectra

作　　者：申红玉[1] 张宏宇[1] 陈敏[1] 郑国军[1] 朱珉之[1] 杭双熊[1] SHEN Hongyu;ZHANG Hongyu;CHEN Min;ZHENG Guojun;ZHU Minzhi;HANG Shuangxiong(Department of Clinical Laboratory,the Third Peoples′Hospital of Changzhou,Changzhou 213001,China)

机构地区：[1]江苏省常州市第三人民医院检验科

出　　处：《实用医学杂志》2020年第3期344-348,共5页The Journal of Practical Medicine

基　　金：江苏省常州市卫生计生委科技项目(编号：ZD201814)

摘　　要：目的本研究旨在探讨乙肝表面抗原(HBsAg)滴度、HBV DNA水平与乙肝基因突变位点的相关性,确定耐药突变是否会影响HBsAg水平。方法本研究共纳入2843例患者。所有患者首先分为突变组和非突变组,然后根据突变位点将突变组分为M204I/V、L180M+M204V、L180M+M204I、A181T、N236T、A181T+N236T等组别。同时收集患者HBsAg、HBV DNA、肝功能和HBV基因分型等资料,采用t检验对正态分布数据进行组间比较,χ2检验用于分类数据的比较,pearson相关分析描述两个变量之间的相关性。结果耐药突变组与非突变组间HBV DNA水平差异有统计学意义(t=7.675,P<0.001)。非突变组和各突变组血清HBsAg滴度与HBV DNA水平呈正相关(非突变组:r=0.413,P<0.001;rtM204I/V:r=0.380,P<0.001;L180M+M204V:r=0.300,P<0.001;rtA181V:r=0.258,P=0.008;rtN236T:r=0.369,P=0.004),但rtL180M+rtM204I突变组和rtA181V+rtN236T突变组血清HBsAg滴度与HBV DNA水平无相关性。L180M+M204I突变组HBV DNA水平显著高于M204I/V和L180M+M204V突变组(t=-4.362,P<0.001;t=-3.763,P<0.001)。rtA181T+rtN236T突变组血清HBsAg滴度明显低于N236T单位点突变组(t=2.005,P=0.038)。结论HBV RT区不同变异影响HBsAg水平及其和HBV DNA的相关性。Objective To investigate the correlation between HBsAg titer,HBV DNA level and mutation site of HBV gene,and to determine whether drug resistance mutation could affect HBsAg level.Methods A total of 2843 patients who underwent genotypic resistance tests were enrolled in this study.All patients were divided into five sub⁃groups,including M204I/V,L180M+M204V,L180M+M204I,A181T/V,N236T and A181T/V+N236T according to the mutation spectra.Serum HBsAg,hepatitis B virus DNA(HBV⁃DNA),alanine aminotransferase(ALT)and HBV serologic markers were qualified meanwhile.Normal distribution data were compared by indepen⁃dent⁃samples t test,andχ2 test was used for comparison of classified data.Pearson correlation analysis described the correlation between the two variables.Results HBV DNA was lower in drug⁃resistance mutation as compared to the non⁃mutation groups(t=7.675,P<0.001).HBsAg was positively correlated with HBV DNA levels in the non⁃mutation group(r=0.413,P<0.001),as well as in the M204I/V(r=0.380,P<0.001),L180M+M204V(r=0.300,P<0.001),A181T(r=0.258,P=0.008),and N236T subgroups(r=0.369,P=0.004).No correlation was found in the L180M+M204I(r=0.203,P=0.055)and A181T/V+N236T subgroup(r=0.159,P=0.217).Moreover,for patients with L180M+M204I mutation,HBV DNA level was significantly higher than that in M204I/V and L180M+M204V mutation groups(t=-4.362,P<0.001;t=-3.763,P<0.001),but showed no differences among A181T,N236T,A181T+N236T subgroups.For patients with A181T+N236T muta⁃tion,HBsAg was obviously lower than that in N236T subgroup(t=2.005,P=0.038).Conclusion Different variations in HBV RT region affected HBsAg level and its correlation with HBV DNA.

关 键 词：乙型肝炎 基因突变 乙肝表面抗原(HBsAg) HBV DNA 耐药 

分 类 号：R575.1[医药卫生—消化系统]