拉米夫定对慢性乙型肝炎病人YMDD变异影响及相关因素分析

THE INFLUENCE OF LAMIVUDINE ON YMDD VARIATION IN PATIENTS WITH CHRONIC HEPETITIS B

目的探讨拉米夫定对慢性乙型肝炎(CHB)病人发生酪氨酸-蛋氨酸-天冬氨酸-天冬氨酸(YMDD)变异影响及相关因素,为核苷(酸)类似物耐药分析提供参考。方法选择初始采用拉米夫定单药治疗的CHB病人63例,根据有无发生YMDD变异分为变异组(45例)和未变异组(18例)。所有相关因素通过问卷形式获得并进行统计学分析。结果两组HBV DNA转阴率比较差异有显著性(χ2=4.33,P<0.05),未变异组的HBeAg转阴率明显高于变异组,差异有显著性(χ2=12.61,P<0.01)。两组病人依从性、吸烟、饮酒、年龄、HBeAg阳性率等比较差异无统计学意义。结论 YMDD变异与病人依从性、吸烟、饮酒、年龄、HBeAg阳性等无相关性,与HBVDNA长期不转阴及血清学不应答有关。

Objective To investigate the factors associated with tyrosine-methionine-aspartic acid-aspartic acid（YMDD） variation caused by lamivudine therapy for patients with chronic hepatitis B（CHB）,and provide a reference for resistance analysis of nucleotide/nucleoside analogue.Methods A total of 63 CHB patients initially treated with unique lamivudine were selected,who were divided into variation group（45 cases） and un-variation group（18 cases） based on whether there was YMDD variation.All the factors concerned were obtained through a questionnaire and analyzed statistically.Results The difference of the HBV DNA-negative-returning rate between the two groups was significant（χ2=4.33,P0.04）;the negative-returning rate of HBeAg in the un-variation group was higher than variation group,a significant difference was noted between them（χ2=12.61,P0.01）.The differences between the two groups were not significant in terms of patient＇s compliance,smoking,alcohol drinking,age,and HBeAg positive.Conclusion YMDD variation is not correlated with patient＇s compliance,smoking,alcohol drinking,age,and HBeAg positive,but associated with long-term HBV DNA positive and no serological response.