四川地区乙型肝炎病毒基因分型与耐药突变分析  

Analysis on the genotypes and resistance gene mutation of chronic hepatitis B virus in Sichuan

作　　者：林瑞 陈竹 陈艳 王丽 陈雄 LIN Rui;CHEN Zhu;CHEN Yan;WANG Li;CHEN Xiong(GCP Office,Hepatitis Department,Public Health Clinical Center of Chengdu,Sichuan 610066,China)

机构地区：[1]成都市公共卫生临床医疗中心GCP办公室,四川610066 [2]成都市公共卫生临床医疗中心肝病科,四川610066

出　　处：《肝脏》2020年第11期1165-1167,共3页Chinese Hepatology

基　　金：四川省医学科研青年创新课题计划(Q14020);成都市卫计委科研课题(2015125)。

摘　　要：目的观察四川地区慢性乙型肝炎患者的乙肝病毒基因分型和耐药突变情况,为抗病毒治疗提供参考依据。方法检测2017年1月至2018年12月成都市公共卫生临床医疗中心收治的489例反复肝功异常的慢性乙肝患者的HBV基因型、耐药突变位点、肝功、HBeAg及HBV-DNA等指标。结果本组患者年龄11~82岁,平均年龄(40.31±7.64)岁,以男性为主(332例,占67.89%)。乙肝病毒基因型以B型(334例,68.30%)和C型(135例,占27.61%)为主,有288例患者发生了耐药突变(耐药率为58.90%,288/489),年龄13~75岁,平均年龄(40.78±8.62)岁。其中,单个位点突变者98例(34.03占%,98/288),包括rtM 204I(V)突变36例、rtL180M突变31例和rtN236T突变31例;2个位点突变者112例(占38.89%,112/288),以rtL180M合并rtM204I(V)突变(76例,占67.86%,76/112)最常见;3个及以上位点突变者78例(占27.08%,78/288),系在rtL180M、rtM204 I(V)突变的基础上合并rtN236T、rtA181V、rtA194T、rtS202或rtM250等位点的突变。B型的耐药突变率明显高于C型及其他基因型,差异有统计学意义(χ2=10.38,P=0.0056)。结论四川地区慢性乙型肝炎患者的HBV基因型以B型和C型为主。临床医生对于反复肝功异常者需警惕耐药突变的可能,并根据患者的耐药突变情况制定个体化的抗病毒治疗方案。Objective To observe the genotypes and resistance gene mutation of chronic hepatitis B virus in Sichuan to provide reference for antiviral therapy.Methods The index including HBV genotype,resistance gene mutation,liver function,HBeAg and HBV-DNA load of 489 patients with repeated abnormal liver function,who infected with chronic hepatitis B virus(CHB),in our hospital from Jan.2017 to Dec.2018 were examined.Results In our study,the age of patients were 11 to 82,the average was 40.31±7.64,and the number of male was more than female(332 men,67.89%).The main HBV genotype was type B(68.30%,334/489)and type C(27.61%,135/489),and there were 228 patients were founded drug-resistant mutation(58.90%,288/489),age from 13 to 75(the average was 40.78±8.62).We found that the single site resistance gene mutation was 98 cases(34.03%,98/288),including the rtM204I(V)site mutation(36 cases),rtL180M mutation(31 cases)and rtN236T mutation(31 cases).The two sites mutation was totally 112 cases(38.89%,112/288),in which the most common mutation was rtL180M combined with rtM204I(V)(76 cases,67.86%,76/112).The three sites mutation was 78 cases(37.08%,78/288),which was based on rtL180M,rtM204 I(V)sites combined with rtN236T,rtA181V,rtA194T,rtS202 or rtM250.The drug resistance rate of type B was significantly higher than that of type C and other genotypes(χ2=10.38,P=0.0056).Conclusion The main genotypes of HBV in Sichuan are type B and type C.Clinicians should be alert to the possibility of drug-resistant mutations in patients with repeated abnormal liver function and formulate individualized antiviral treatment plans according to the drug-resistant mutations.

关 键 词：乙肝病毒 基因型 耐药突变 

分 类 号：R512.62[医药卫生—内科学]