HBeAg阳性和阴性慢性乙型肝炎患者YMDD的变异

YMDD mutations of HBV in HBeAg positive and HBeAg negative chronic hepatitis B

目的研究YMDD变异在HBeAg阳性和HBeAg阴性乙型肝炎病毒(HBV)感染者中发生的情况。方法对我科接受拉米夫定治疗的247例慢性乙型肝炎患者进行定期随访,检测肝功能和HBV病毒学指标,利用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)检测YMDD变异,利用实时定量PCR检测HBV DNA定量以及利用Abbott试剂检测HBV标志物,对比分析HBeAg阳性和HBeAg阴性患者中YMDD变异的发生情况。结果247例患者中共有42例出现YMDD变异,YMDD变异的累积发生率随着时间的延长逐年增加。与治疗前HBeAg阴性患者相比,治疗前HBeAg阳性患者YMDD变异的发生率明显高于治疗前HBeAg阴性患者。结论HBeAg阳性患者YMDD变异年累积发生率高于HBeAg阴性患者。

Objective To compare the occurrence of YMDD mutations in patients with HBeAg positve and HBeAg negative chronic hepatitis. Methods Two hundred and forty seven chronic hepatitis B patients who received lamivudine treatment were followed up. Liver function tests and hepatitis B virological tests including YMDD mutant analysis, HBV DNA quantitation and HBV serological marker analysis were performed regularly. Results YMDD mutants were detected in forty two patients. The cumulative rate of occurrence of YMDD mutation increased with the duration of lamivudine treatment. The mutation rate was significantly higher in pretreatment HBeAg positive patients than that in HBeAg negative patients. The ALT flare was more evident after emergence of YMDD mutants in pretreatment HBeAg positive patients than that in HBeAg negative patients. Conclusions The cumulative rate of occurrence of YMDD mutation was higher in pretreatment HBeAg positive patients than that in pretreatment HBeAg negative patients.