永川地区慢性乙型肝炎患者病毒基因分型及耐药性研究

The study on genotypes and drug resistance-mutations of HBV in chronic hepatitis B patients in Yongchuan area

目的探讨永川地区慢性乙型肝炎患者乙型肝炎病毒类型分布、耐药情况及其临床意义。方法采用基因芯片法对605例慢性乙型肝炎患者经核苷(酸)类似物治疗后,进行耐药情况分析,并对发生耐药的乙型肝炎DNA进行分析。结果永川地区605例慢性乙型肝炎患者的基因分型以B型为主63.1%,116例慢性乙型肝炎患者出现不同位点耐药,耐药率为19.17%。耐药突变型以B型为主,其中对阿德福韦酯耐药占所有耐药突变的49.14%且以B型逆转录酶236T为主,为35.09%;拉米夫定耐药以B型逆转录酶108 M为主,占34.29%,荧光定量PCR仪检测发现发生耐药患者的病毒复制数与未发生耐药患者病毒复制数存在差异(P<0.05)。结论监测慢性乙型肝炎患者HBV耐药基因突变情况,有助于早发现临床乙型肝炎耐药患者,指导临床合理应用抗病毒药治疗乙型肝炎,提高治疗效果。

Objective To investigate the relationship among HBV genotypes ,nucleoside analogues drug resistance-mutations and the patients with chronic hepatitis B in Yongchuan area .Methods The gene chip was used to detect the nucleoside analogues drug resistance-mutations of 605 cases with chronic hepatitis B ,and the HBV-DNA level was analysised after the antiviral therapy .Re-sults Among 605 cases ,63 .1% genotype were genotype B ,116 cases（19 .17% ） were found to be resistance mutants .The major drug resistance-mutations was genotype B ,49 .14% drug resistance-mutations was Adefovir drug resistance-mutations ,and the re-sistance rate of genotype B with reverse transcriptase 236T mutation was 35 .09% .The resistance rate of genotype B Lamivudine drug resistance-mutations with reverse transcriptase 108M mutation was 34 .29% ,the virus replication between resistance and non-resistant virus were significant difference （P〈0 .05） .Conclusion To monitor the hepatitis B patients with HBV resistance gene mutations is beneficial to detect the patients with drug resistance-mutations early ,which is important for selecting reasonable treat-ment methods in clinical practice .