太仓市慢性乙型肝炎患者耐药突变和基因型分布研究

Distribution of drug resistance mutations and genotypes in patients with chronic hepatitis B in Taicang city

目的研究太仓地区慢性乙肝患者耐药突变和基因型分布情况,及HBV基因型与耐药突变的相关性。方法选择太仓地区350例慢性乙型肝炎患者,在使用核苷(酸)类药物抗病毒前,检测患者耐药突变及基因型情况,分析患者耐药突变与基因型的相关性。结果 350例慢性乙肝患者,HBV基因型分布:B基因型172例,占49.14%;C基因型164例,占46.85%;其中D基因型9例,占2.57%;B、C混合型基因型有5例,占1.42%;未发现其他基因型。本研究共检出58例耐药突变患者,其中B基因型22例,C基因型35例,D基因型1例,B、C混合基因型患者未发现耐药突变。耐药突变位点:与拉米夫定相关的耐药突变36例(10.28%),与阿德福韦相关的耐药突变16例(4.57%),与恩替卡韦相关的耐药突变6例(1.71%)。结论太仓地区慢性乙肝患者HBV基因型以B、C型为主,2种基因型占90%以上,两种基因型比例相似。C基因型患者发生耐药突变的比例较B基因型高,拉米夫定相关的耐药突变比例最高。建议对用药史不明确、复发再治疗的慢性乙肝患者,在接受核苷(酸)类药物治疗前进行耐药检测,选择针对性治疗方案。

Objective To study the distribution of drug resistance mutations and genotypes in the patients with chronic hepatitis B（CHB）in Taicang area.Methods 350 cases of CHB were selected and detect the drug resistance mutations and genotypes before using nucleoside（acid）anti-viral drugs.The correlation between the drug resistance mutations with genotypes in CHB patients was analyzed.Results Among 350 cases of CHB,the distribution of genotypes was genotype B in 172 cases,accounting for 49.14%, genotype C in 164 cases,accounting for 46.85%,genotype D in 9 cases,accounting for 2.57%,mixed genotype of B and C in 5 ca-ses,accounting for 1.42%,no other genotypes were found.In this study,the drug resistance mutations were detected in 58 cases,in-cluding 22 cases of genotype B,35 cases of genotype C and 1 case of genotype D,no drug resistance mutations were found in mixed genotype B and C.The drug resistance mutations sites：lamivudine resistance-associated mutations in 36 cases（10.28%）,and adefo-vir resistance-associated mutations in 16 cases（4.57%）and entecavir associated resistance mutations in 6 cases（1.71%）.Conclusion The genotype of CHB patients in Taicang area was dominated by genotype B and C,which accounting for more than 90% and the proportion of these two kinds of genotype is similar.The proportion of drug resistance mutation occurrence in the patients with gen-otype C is higher than that with genotype B.The lamivudine resistance-associated mutation has the highest proportion of drug re-sistance occurrence.It is suggested that the CHB patients with undefined medication history and recurrence treatment should be per-formed the drug resistance detection for selecting the targeted therapeutic schemes before accepting nucleoside（acid）drug therapy.