基因芯片技术检测拉米夫定治疗过程中乙型肝炎病毒变异的临床意义

Detection of mutation in precore,basic core promoter and P domains by gene chip in rebound patients with chronic hepatitis B during lamivudine treatment.

目的探讨基因多态性诊断芯片在拉米夫定治疗慢性乙型肝炎中乙型肝炎病毒变异的临床意义。方法应用点样法制备的乙型肝炎病毒基因多态性诊断芯片对HBV前C与BCP区和P区基因包括(YMDD基序)的6个位点进行检测。结果60例患者中58例出现了基因变异,但前C/BCP区/P区各位点突变率比较无显著性差异(x2=0.97,P>0.05)。变异后血清ALT逐渐升高,在YMDD变异后,89.4%患者出现肝功能异常,3位点以上变异组为86.6%。3位点以上变异者出现HBeAg/抗HBe血清转换率为56.6%。BCP区双突变者血清转换率为35.7%,YMDD位点血清转换率为42.1%。结论拉米夫定治疗HBV感染的复发与病毒突变密切相关,但与何种位点突变更有关系,尚不清楚。

Objective To investigate the mutation in precore,bssic core promoter and P domains in rebound patients with chronic hepatitis B during lamivudine treatment.Methods The mutation in precore,basic core promoter and P domains were detected by gene chip.Results In 60 rebound patients with chronic hepatitis B during lamivudine treatment,58 had gene mutation,but the incidence of mutation in precore,basic core promoter or P domains had no superior one ( x 2=0.97, P >0.05).The serum alanine transaminase level gradually increased in patients with gene mutation,and the abnormal rates of liver function test were 89.4% and 86.6%,respectively in YMDD and in the three domain mutation.The HBeAg/anti Hbe seroconversion were 56.6%,35.7% and 42.1%,respectively,in mutation of precore,basic core promoter and P domains.Conclusion Gene mutation leads to rebound of liver function test in patients with chronic hepatitis B,and mutation in which motif is likely to damage liver function needs further study.