拉米夫定治疗前后YMDD变异与HBV—DNA水平相关性分析

The Analysis of Relativity of the YMDD Variation and HBV-DNA Content among the CHB Suffers after Curing by Lamivudine

目的：通过对慢性乙型肝炎（CHB）患者血液中HBV—DNA、谷丙转氨酶（ALT）、r-谷氨酰转移酶（r—GT）的检测，了解CHB患者经拉米夫定（3TC）治疗前后HBV—YMDD变异情况，分析HBV—YMDD变异与HBV—DNA、ALT、r—GT相关情况，探讨3TC治疗CHB的效果以寻找最佳治疗方案。方法：对71例治疗前CHB患者，检测HBV—YMDD变异株；选择64例HBV-YMDD的CHB患者经治疗1年后，检测HBV—YMDD变异株；选择36例患者经治疗后仍然是YMDD;13例经治疗后由YMDD变为YIDD；5例治疗后由YMDD变为YVDD的；9例经治疗后由YMDD变异为YMDD＋YVDD混和型的CHB进行检测HBV—DNA、ALT、r—GT含量。结果：71例CHB用3TC治疗前已有7例存在变异现象，其中2例是YVDD型；3例是YIDD型；2例是YMDD＋YVDD混合型；64例治疗前为YMDD型的患者，用3TC治疗后36例没有变异、5例变异为YVDD、13例变异为YIDD、9例变异为YMDD＋YVDD、1例变异为YMDD＋YIDD；36例治疗前后DNA没有变异的CHB，治疗前后的HBV-DNA、ALT、r—GT含量差异有显著意义；13例治疗后由YMDD变为YIDD，治疗前后的HBV—DNA含量差异有显著性，而ALT、r—GT含量在治疗前后差异无显著意义；5例治疗后由YM-DD变为YVDD和9例经治疗后由YMDD变异为YMDD＋YVDD混和型，治疗前后HBV—DNA、ALT、r—GT含量差异无显著意义。结论：CHB用3TC治疗前已经存在着9.85％变异率。64例YMDD用3TC治疗1年后，有43．75％发生变异，变异的类型以YIDD为主。HBV—YMDD没有变异时，经3TC治疗CHB后患者的HBV-DNA、ALT、r—GT含量比治疗前有较大降低，效果明显。YMDD变异为YIDD时，经治疗后患者血液中的HBV-DNA含量比治疗前有较大降低，而血液中ALT、r—GT含量比治疗前降低不大。YMDD变为YVDD时，其血液中的HBV—DNA量高于治疗前，ALT、r-GT含量比治疗前降低不大。YMDD变为YMDD＋YVDD混和型时，经治后CHB患者血液中的HBV—DNA量比治疗前稍高，ALT、r-GT含量比治疗后降低不大。

Objective To understand the variation of the HBV-YMDD before and after a treatment with Lamivudine （3TC） for those who has infected the hepatitis virus B for a long time（CHB） ,to analyze the related content change of the HBV-DNA, alanine arninotransferase （ALT） and the r-glutamyl transpeptidase （r-GT） ,inquiry the result of the 3TC treatment for C HB and to look for the best treatment project, by inspecting the content of the alanine ALT and r-GT in the blood of those patients. Methods Check the individual HBV-YMDD variant plants of 71 CHB patients before treatment; Examine individual HBV-YMDD variation plants of 64 CHB patients after treatment for one year;First,choose 36 cases still is a YMDD after curing;13 examples change into YIDD from the YMDD after treatment;5 examples change into YVDD from the YMDD after curing and 9 cases after treatment change from the YMDD into the mixture of the YMDD and the YVDD. Then examine the HBV-DNA, ALT and r-GT content for all the chosen CHB. Results There already arevariation in 7 of the 71 examples before the treatment using the 3TC ,2 among which are the YVDD type;3 are YIDD type ;2 are the mixture type of YMDD and YVDD;64 examples before curing is YMDD type of the CHB sufferer,in which 36 have no variation,5 get variations as YVDD,13 have variations for the YIDD,9 have shown variations for the mixture of the YMDD and the YVDD,and one has got a variation for the mixture of the YMDD and the YIDD after using the 3TC for a treatment;There are 36 CHB suffers whose DNA have got no variation before and after treatment, of which the HBV-DNA, ALT,the r-GT content in front and back the cure has already shown obvious mean- ing;13 examples change into the YIDD from the YMDD after curing,the HBV-DNA content before and after the treatment has already shown obvious difference, but the ALT, r-GT content do not show obvious meaning; The content difference of HBV- DNA, ALT,the r-GT before and after the curing of the 5 examples which change into YVDD from the YMDD and 9 cases which change into YVDD-YMDD mixtrue from the YMDD doesnt show great meaning. Conclusion There has already existed 9.85% variation rates before treatment using a 3TC in the CHB patients. There is 43.75% variation in 64 YMDD cases when curing with the 3TC after a year,and the main type of variation is regarded as the YIDD type. When HBV-YMDD has no variation, ALT,r-GT content of the CHB patients,which shows that the treatment effect of 3TC is obvius. If YMDD variation is YIDD, HBV-DNA in the blood after treatment of CHB suffers falls a lot then before but the content of ALT and r-GT shows little change then before. When YMDD changes into YVDD, HBV-DNA in the blood after treatment of CHB suffers increas then before but the content of ALT and r-GT shows little change then before. If YMDD changed into YMDD-YVDD mixtrue,after curing the CHB sufferer＇s HBV-DNA content in blood is slightly higher than the treatment, but the ALT,the r-GT content ratio falls little after curing.