未予核苷(酸)类似物治疗慢性乙型肝炎病毒感染者YMDD变异及特点

Treatment of YMDD Mutation in Patients with Hepatitis B Virus without Nucleoside Analogues and Its Features

目的探讨未予核苷(酸)类似物(NA)治疗乙型肝炎病毒(HBV)慢性感染者P基因YMDD基序变异对于血清肝脏生化指标的影响,及YMDD变异两种形式YIDD/YVDD与HBV e抗原(HBeAg)的关系。方法采用引物特异性实时荧光聚合酶链反应(PCR)法检测慢性HBV感染者外周血HBV P基因区YIDD/YVDD变异及HBVDNA载量,并检测HBeAg、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)的水平。结果 334例未经NA抗病毒治疗的慢性HBV感染者中,HBV未变异300例,YVDD变异23例,YIDD变异9例,YIDD、YVDD共生株2例。慢性HBV感染者HBeAg阳性与YIDD变异有关(P<0.05),与YVDD变异无关(P>0.05)。YMDD变异者与未变异者AST、ALT水平比较,差异均有统计学意义(P<0.05);而HBV DNA比较,差异无统计学意义(P>0.05)。结论 HBV感染者发生YIDD/YVDD变异者,其血清ALT、AST水平均低于未变异者。HBeAg阳性者可能更易发生HBV YIDD变异,而YVDD变异可能与HBeAg状态无关。

Objective To investigate the effect on biochemical parameters of serum and liver by treatment of YMDD mutation in patients with hepatitis B virus without nucleoside analogues and to investigate the relationship between the two mutation forms of YIDD/YVDD and HBeAg.Methods YIDD/YVDD mutation and HBV DNA load were detected by primer-specific real-time PCR in patients with chronic HBV infection.The levels of HBeAg,ALT and AST were also detected.Results Among the 334 patients who was not given nucleoside analogues treatment,YMDD mutation was found in 300 subjects,YIDD in 9,and YVDD in 23.YIDD/YVDD co-existed in 2 subjects.Positive HBeAg was related to YIDD mutation in patients with chronic HBV infection（P0.05）,but not related to YVDD（P0.05）.The levels of AST and ALT between patients with YMDD mutation and those without mutation showed statistically significant differences（P0.05）,while the level of HBV DNA showed no statistically significant difference（P0.05）.Conclusion Patients with HBV infection will have lower ALT and AST levels when they have YIDD/YVDD mutation compared with those without mutation.Patients with positive HBeAg will more likely have HBV YIDD mutation,and the YVDD mutation may be not related to HBeAg status.