慢性乙型肝炎患者应用拉米夫定治疗发生HBV YMDD变异的研究

Study on YMDD Mutation in Patients with Chronic Hepatitis B after Treatment with Lamivudine

目的 探讨慢性乙型肝炎（CHB）患者应用拉米夫定治疗发生HBV YMDD变异后与患者血清HBVDNA载量关系的临床意义.方法 选择46例应用拉米夫定治疗并发生HBV YMDD变异的CHB患者,另选择未发生HBV YMDD变异的CHB患者作对照组.探讨血清HBVDNA载量与HBV YMDD变异类型、变异发生时间的关系.结果 CHB患者接受拉米夫定治疗前,HBV YMDD变异组HBVDNA载量明显高于HBV YMDD未变异组（P〈0.01）.HBV YMDD变异类型（YVDD、YIDD、YVDD/YIDD）的分布与血清HBVDNA载量无相关性.HBVDNA载量与发生HBV YMDD变异的时间有相关性.随着HBVDNA载量的升高,发生HBV YMDD变异的时间越来越早.结论 应用荧光定量PCR方法检测血清HBVDNA载量和HBV YMDD变异,可动态观察CHB患者拉米夫定治疗后发生HBV YMDD变异的情况,对临床治疗和观察预后具有重要的临床意义.

Objective To investigate the relationship between the occurrence of YMDD mutation in patients with chronic Hepatitis B （CHB） after treatment with lamivudine and serum HBV DNA levels. Methods Choose 46 CHB patients with YMDD mutation after treatment with lamivudine as experimental group, choose CHB patients which did not occurre YMDD mutation as control group. To investigate the rela- tionship among serum HBV DNA levels, types of YMDD mutation and the time of YMDD mutation occttrred. Results Before CHB patients re- ceived lamivudine treatment, the HBV DNA levels of YMDD mutation group are obvious higher than control group. （p 〈 0.01 ）. There were no correlation between the types of YMDD mutation （YVDD Y1DD YIDI）/YVDD） and the serum HBV DNA levels. There were correlation between the serum HBV DNA levels and the time of YMDD mutation occurred. The time of YMDD mutation occurred is increasingly early, with the rise of HBV DNA levels. Conclusion The detections of serum HBV DNA levels and YMDD mutation by fluorescence quantitative PCR, may dynamically observe the situation of YMDD mutation, which have important clinical significance to the selections of treatment protocols and observations of prognoses.