我国部分地区HBV基因型和耐药性分布特点  

Distribution characteristics of HBV genotypes and drug resistance in several areas of China

作　　者：曾征宇[1] 王琳 温俊雄 代艳峰 周丽珍 郭晓磊[1] ZENG Zheng-yu;WANG Lin;WEN Jun-xiong;DAI Yan-feng;ZHOU Li-zhen;GUO Xiao-lei(Guangzhou Kingmed Laboratory Science Center,Guangdong Guangzhou,510000)

机构地区：[1]广州金域医学检验中心有限公司实验诊断部,广东广州510000

出　　处：《中国病原生物学杂志》2021年第5期570-576,共7页Journal of Pathogen Biology

摘　　要：目的分析我国部分地区慢性乙型肝炎患者HBV基因型和耐药性分布特点。方法选择2016年1月-2019年12月于广州金域检验中心有限公司进行HBV基因型和耐药突变检测的乙肝患者14374例,采集血液标本并分离血清,提取HBV DNA,通过PCR+Sanger测序法检测并分析HBV基因型和耐药突变,应用Personχ^(2)检验或Fisher确切概率法进行统计分析。结果14374例患者的血液标本中共检出7种HBV基因型,其中A基因型1例(占0.01%)、B基因型4728例(占32.89%)、C基因型9500例(占66.09%)、C/D重组基因型64例(占0.45%)、D基因型65例(占0.45%)、G基因型10例(占0.07%)、B/C重组基因型6例(占0.04%),以B、C型为主。B、C基因型在不同年龄和性别中的分布差异有统计学意义(P<0.01)。5488例发生耐药突变,耐药突变率为38.2%,B基因型中检出耐药突变1572例,突变率33.2%,NAs耐药株主要有FTC+LAM+LDT 846例(占17.9%)、FTC+ETV+LAM+LDT 348例(占7.4%)、ADV 315例(占6.7%);C基因型中检出耐药突变3868例,突变率40.7%,NA耐药株主要有FTC+LAM+LDT 1563例(占16.5%)、ADV 993例(占10.5%)、FTC+ETV+LAM+LDT 985例(占10.4%)。常见的单点耐药突变是rtM204I/V/S,共4093例(占28.5%),其次rtL180M有2970例(占20.7%),rtP237H、rtI169T、rtI233V、rtA194M/T位点的突变较少见。各地区HBV基因主要突变位点均为rtM204I/V/S、rtL180M、rtA181S/T/V,多发生在华东地区,分别为1073例(占37.8%)、838例(占29.5%)、449例(占15.8%),rtL80I/V、rtN/H238D/S/T位点突变主要发生在华南地区354例(占8.9%)、597例(占15%)。结论我国不同地区间HBV主要耐药突变位点存在差异,且突变模式复杂,应根据HBV基因型和耐药突变检测结果对乙型肝炎患者选择合适的治疗方案。Objective To analyze the distribution characteristics of HBV genotypes and drug resistance in patients with chronic hepatitis B in parts of China.Methods A total of 14374blood samples were collected for HBV genotyping and testing for drug resistance mutations by the Guangzhou Kingmed Laboratory Science Center from January 2016to December 2019.Serum was separated and HBV DNA was extracted.Subsequently,all samples were amplified and sequenced using PCR+Sanger sequencing.In order to determine the HBV genotype and identify resistance mutations,a variety of biological software was used for sequencing.Pearson’s chi-square test or Fisher’s exact test was used for statistical analysis.Results A total of 7genotypes were detected in the 14374samples,including 1sample of genotype A(0.01%),4728samples of genotype B(32.89%),9500samples of genotype C(66.09%),and 64samples of genotypes C and D(0.45%),65samples of genotype D(0.45%),10samples of genotype G(0.07%),6samples of recombined genotypes B and C(0.04%).Most samples were of genotype B or C.The distribution of the genotypes B and C differed significantly by age group and gender(P<0.01).Of the total samples,5488contained drug resistance mutations.The rate of a drug resistance mutation was 38.2%.In the 1572samples determined to be genotype B,the rate of a drug resistance mutation was 33.2%.NA-resistant strains mainly included 846samples(17.9%)resistant to FTC+LAM+LDT,348 samples(7.4%)resistant to FTC+ETV+LAM+LDT,and 315samples(6.7%)resistant to ADV.In the 3868samples determined to be genotype C,the rate of a drug resistance mutation was 40.7%.NA-resistant strains mainly included 1563samples(16.5%)resistant to FTC+LAM+LDT,993samples(10.5%)resistant to ADV,and 985samples(10.4%)resistant to FTC+ETV+LAM+LDT.The most common single-site resistance mutation was rtM204I/V/S,which was found in a total of 4093samples(28.5%),followed by rtL180M,which was found in 2970samples(20.7%).The mutations rtP237H,rtI169T,rtI233V,and rtA194M/T were rare.The main resistance mutation in each reg

关 键 词：慢性乙型肝炎 HBV 基因型 耐药突变 

分 类 号：R373.21[医药卫生—病原生物学]