DNA序列测定法与实时荧光PCR法检测YMDD突变结果的比较

The comparison of YMDD mutation results detected by direct sequencing and real-time PCR

目的比较DNA序列测定法与实时荧光法检测YMDD突变的结果,并对除YMDD突变之外的耐药相关基因突变及其意义进行讨论。方法收集89例慢性乙肝患者的92份血清样本,均用实时荧光PCR法做YMDD突变检测。采用巢式PCR法扩增HBV反转录酶(RT)基因,对PCR产物进行DNA双向测序,采用NTI软件比对结果,并对RT基因上其他11个已知耐药相关突变位点进行分析。结果在37份YMDD突变阴性的样本中,DNA测序法检测结果为33份M204M(未突变)、1份M204I、3份M204V;4份YMDD突变阳性样本均为突变/未突变序列共存;另检出7份样本存在ADV耐药相关突变,占18.9%(7/37)。在55份YMDD突变阳性样本中,DNA测序法检测到52份,阳性结果符合率为94.5%(52/55);另检出5例存在ADV或ETV耐药相关突变,占9.1%(5/55)。结论DNA序列测定法检测HBVRT基因耐药相关突变敏感性高,重复性好,与实时荧光PCR方法的检测结果有较高的符合率,可同时检出YMDD突变以外的各种耐药相关突变,有助于临床全面了解患者对核苷(酸)类似物的耐药情况,合理地制订抗HBV治疗方案。

Objective To compare the efficiency of detecting YMDD mutations by direct DNA sequencing and real time fluerescence PCR, and to explore the significance of the mutations of drug resistance gene other than YMDD mutation. Methods 92 serum samples from 89 patients with chronic hepatitis B were collected and all the samples were detected by real-time PCR for YMDD mutation. HBV I）NA was extracted from serum and was amplified by nest PCR to achieve HBV P gene RT region sequence. The PCR products were sequenced at both directions, and the sequencing results were contrasted through NTI program. The other 11 known drug-resistance mutation sites at the HBV RT region were also analyzed. Results Among the 37 samples with no YMDD mutation detected by real-time PCR, 33 samples were with M204M （without mutation）, 1 sample with M204I and 3 samples with M204V by direct sequencing. Mutation and wild-type standard sequences were all coexisted in the 4 positive samples. There were 7 samples detected with ADV resistant mutation, accounting for 18. 9% （7/37）. Among the 55 samples with YMDD mutation detected by real-time PCR, 52 samples were detected by DNA sequencing, the accordance rate was 94. 5%（52/55）; 5 samples with ADV or ETV resistant mutation were detected, accounting for 9. 1% （5/55）. Conclusions Direct DNA sequencing is a high sensitive, repeatable method to detect drug-resistance mutation at RT region of HBV P gene. The result is well consistent with that attained by real-time PCR. Direct DNA sequencing can also detect various drug-resistance mutations as well as YMDD mutation, which is helpful to generally understand the nucleoside analogue resistant mutation and adopt more reasonable therapy projects against HBV.