慢性乙型肝炎患者HBV DNA YMDD变异的检测及意义

Detection of HBV DNA YMDD mutation in patients with chronic hepatitis B and the significance

目的 了解慢性乙型肝炎患者HBVDNAYMDD变异的存在情况及意义。方法 检测 90例慢性乙型肝炎患者HBVDNAYMDD变异 ,对发生HBVDNAYMDD变异的 2 0例患者的肝功能、HBeAg、HBVDNA及HBVDNAYMDD变异情况进行分析。结果 90例慢性乙型肝炎患者中检出HBVDNAYMDD变异共 2 0例 (阳性率 12 0 0 % ) ,已服用拉米夫定者 3 6例 ,检出YMDD变异 9例 (2 5 0 0 % ) ,未服用拉米夫定患者 5 4例 ,检出YMDD变异 11例 (阳性率 2 0 3 7% )。在 2 0例YMDD变异患者中有 5例HBeAg阴性 ;2 0例YMDD变异患者HBVDNA在 3 0 2 1× 10 5～ 2 3 69× 10 8(5 41× 10 7± 7 75× 10 7)copies/ml ,ALT 3 4～ 12 16(2 88 2 0± 3 3 8 0 7)IU/L ,TB 8 9～ 3 2 6 7(4 8 74± 72 2 0 ) μmol/L。 结论 YMDD变异株可在拉米夫定治疗过程中出现 ,也可天然存在 ,YMDD变异可与前C基因变异同时存在 ,提示HBV的变异常常是多位点的 ;YMDD变异株HBV复制处于中～高度水平 ;YMDD变异株的致病性轻重不等 ,肝功能可为正常 ,也可是轻度～高度等不同程度异常。

Objective To investigate the existence of HBV DNA YMDD mutation in patients with chronic hepatitis B and the related significance. Methods HBV DNA YMDD mutation was detected in 90 patients with hepatitis B. The liver function, HbeAg, HBVDNA, and HBV DNA YMDD mutation in patients with HBV DNA YMDD mutation were analyzed. Results HBV DNA YMDD mutation was found in 20 out of 90 patients with hepatitis B (positive rate 12.00%). HBV DNA YMDD mutation was found in 9 out of 36 patients receiving lamivuding therapy (positive rate 25.00%), but HBV DNA YMDD mutation was found in 11 out of 54 patients without lamivuding therapy (positive rate 20.37%). In the 20 patients with HBV DNA YMDD mutation, 5 patients were negative in HBeAg. HBV DNA, ALT, and Tb of the 20 patients with HBV DNA YMDD mutation were 3.0221×10 5-2.369×10 8 (5.41±7.75×10 7) copies/ml, 34 -1 216 (288.20±338.07) IU/L, and 8.9-326.7 (48.74±72.20) μmol/L, respectively. Conclusion HBV DNA YMDD mutation may occur during the process of lamivuding therapy or may exist naturally. YMDD mutation may co-exist with pre-C gene mutation, suggesting that mutation often occurs in many sites in HBV genes. The reproduction level of HBV DNA ranges from the middle to the high levels. The pathogenicity of YMDD mutation species is various. The liver function may be normal and may also be abnormal in various degrees in these patients with HBV DNA YMDD mutation.