乙型肝炎治疗前后HBV YMDD变异与血清HBV-DNA定量水平的相关性

Relationship between the YMDD mutants of HBV and serum HBV DNA level

目的探讨拉米夫定治疗乙型肝炎前后YMDD变异与HBV-DNA定量水平之间的关系。方法 78例慢性乙型病毒性肝炎患者服用拉米夫定片,100mg/d,并随访2年。于治疗后每隔3个月采用全自动生化分析仪检测肝功能,用ELISA法检测乙肝五项指标,用荧光定量PCR方法检测HBV-DNA水平,用限制性片段长度多态分析法（PCR-RFLP）检测YMDD变异。结果 YMDD变异组治疗前血清HBV-DNA定量水平显著高于未产生YMDD变异组,产生变异的时间与血清HBV-DNA定量水平相关。结论慢性乙型病毒性肝炎患者治疗前血清病毒载量水平超高,应用拉米夫定治疗容易产生YMDD变异,且产生时间早。随着拉米夫定用药时间的延长,出现变异株的病例增加。

Objective To investigate the relationship between lamivudine -resistant （YMDD） mutants of hepatitis B virus （HBV） and serum HBV DNA level. Methods Seventy-eight patients were enrolled in the study, prescribed with lamivudine tablet at the oral dose of 100mg once a day and followed-up for two years. During the treatment, the liver function was tested by Olympus AU640 automatic biochemical analyzer, the HBV-markers were detected by ELISA, serum HBV DNA level was measured with PCR and HBV YMDD mutants were detected using mismatched PCR-restriction fragment length polymorphism （PCR-RFLP） every three months. Results HBV DNA level was significantly higher in patients with YMDD mutants during lamivudine therapy than those without YMDD mutants. Conclusion The higher the patients’serum HBV DNA level is, the easier and earlier the YMDD mutant comes into being if lamivudine is administered. The prolonged lamivudine therapy would increase the incidence of HBV YMDD variation.