拉米夫定治疗53例HBV基因型对乙型肝炎患者P基因突变的影响

Effect of Lamivudine therapy on P gene mutations in 53 patients with chronic hepatitis B

目的探讨HBV基因型与拉米夫定耐药者P基因突变的关系。方法 53例慢性乙型肝炎(CHB)患者经拉米夫定治疗每天100 mg,并于治疗前及治疗后3、6、12、15、18、24个月监测肝功能、HBV M、HBV DNA、HBV基因型及YMDD变异。结果 (1)B基因型占56.60%(30/53),C基因型占41.51%(22/53);(2)在CHB重度及肝硬化病例中C基因型的检出率高于B基因型(P<0.05);(3)拉米夫定治疗后C基因型较B基因型更易发生YMDD变异(P>0.05);(4)B基因型主要发生rtM204I位点突变(62.5%,5/8),而C基因型则主要发生rtL180M/M204V突变(77.78%,7/9)。结论 (1)遵义地区的HBV基因型主要由B、C基因型构成;(2)拉米夫定治疗后C基因型更易发生YMDD变异。

Objective To investigate the association between genetypes of HBV and gene P mutation in patients with resistance to Lamivudine.Methods 53 patients diagnosed as Chronic Hepatitis B（CHB） were treated by 100mg Lamivudin everyday,Liver function,HBV M,HBV DNA,HBV genetypes and YMDD variation were detected in prior treatment and the 3th,6th,12th,15th,18th,24th month of post-treatment.Results（1） Genetype B was 56.6%（30/53）,genetype C was 41.51%（22/53）;（2）Detection rate of genetype C was higher than genetype B in severe Chronic Hepatitis B and hepatic cirrhosis cases（P〈0.05）;（3）YMDD variation was easier to find in genetype C than genetype B in patients treated by Lamivudin（P〈0.05）;（4）The main mutable site of genetype B was rtM204I（62.5%,5/8）,and the mutation of genetype C was rtL180M/ M204V mainly（77.8%,7/9）.Conclusion（1）HBV genetypes in Zunyi area are mainly composed by genetype B,C;（2）genetype C is easier to show YMDD variation after treatment by Lamivudin.