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

目的应用PCRmnh-ELISA法对HBV DNA YMDD变异进行检测,并对其临床意义进行初步研究。方法对我院2006年249例服用拉米夫定的慢性乙肝患者,男187例,女62例,其中HBeAg阳性198例,阴性59例,采用PCRmnh-ELISA法进行YMDD变异株检测,并进行了肝功能及HBV DNA的随访。结果249例患者中,43例YMDD变异阳性,阳性率为17.3%,其中YVDD变异33例,YIDD变异10例。YMDD变株阳性结果中,29例ALT水平呈现反复现象,占阳性结果中的67.4%,34例患者HBV DNA反跳,占阳性结果中的79.1%。结论HBV DNA YMDD变异是拉米夫定产生耐药,使病情反复的主要原因,变异的主要形式可能是YVDD,变异的发生率与E抗原阳性率无关,与治疗前的HBV DNA水平有关。

Objective To detect HBV DNA YMDD mutation by PCRmnh - ELISA, and to preliminarily analyze its clinical significance. Methods Totally 249 patients with chronic hepatitis B who were treated with lamivudine in our hospital in 2006 were involved in this study. There were 187 males and 62 females, including 190 masculines and 59 negatives. YMDD mutation was detected by PCRmnh- ELiSA. Hepatic function and HBV DNA were followed - up. Results Among the 249 patients, 43 of them were variant masculine of YMDD with the mutation rate of 17.3, 33 of them were YIDD variants and 10 of them were YIDD variants. Among the masculine result of YMDD variants, 29 of them showed repeated exposure in the level of ALT, which accounted for 67.4 % in the masculine results. 34 patients showed rebound relapse of HBV DNA, which accounted for 79.1% in the masculine results. Conclusions The HBV DNA YMDD mutation is the main reason of bringing the drug resistance for lamivudine and causing the repeated illness. The main form of variance is possibly the YVDD, and the incidence rate has nothing to do with the masculine of E - antigen. But it has relation with the level of HBV DNA in prior treatment.