武汉地区157例乙型肝炎病毒基因分型和耐药性分析

Analysis of the genotypes and drug resistance of hepatitis B virus in 157 patients in Wuhan district

目的了解武汉市乙型肝炎病毒基因型分布特点和乙型肝炎病毒耐药情况。方法采用基因测序法检测武汉市区157例患者HBV基因型,目标检测基因型为A^H等8个基因型,检测HBV 11个耐药位点:rt L80、rt L169、rt V173、rt L180、rt A181、rt T184、rt A194、rt S202、rt M204、rt N236和rt M250,判断对HBV耐药的核苷类似物。结果武汉市区157例HBV感染者中,检出3种HBV基因型,其中B型占72.61%,C型占26.75%,D型占0.64%。共有68例(43.31%)耐药,其中B型70.59%,C型29.41%,基因B型和C型的HBV相比,耐药发生差异无统计学意义(χ2=0.379,P>0.05)。对拉米夫定耐药41例,占全部耐药病例的60.29%,其中B型占73.17%,C型占26.83%;204I位点耐药17例,180M+204I位点耐药6例,180M+204V位点耐药12例,180M+204V/I位点耐药6例。对阿德福韦酯耐药20例,占全部耐药病例的29.41%,基因B型占75.0%,基因C型占25.0%,耐药位点为236T为9例,耐药位点为181T/V为7例,236T和181T/V联合耐药4例。对恩替卡韦耐药5例,占全部耐药病例的7.35%,基因B型3例,基因C型2例。拉米夫定和阿德福韦酯联合耐药2例,占全部耐药病例的2.94%,均为基因C型。替比夫定耐药与其他核苷类似物耐药分析结果重复,共32例,占47.06%,基因B型75.0%,基因C型25.0%。结论武汉市区157例乙型肝炎病毒感染者中男性较多,感染HBV主要基因型为B型,其次为C型,患者主要表现为拉米夫定、替比夫定和阿德福韦酯耐药。临床应根据患者HBV基因型和耐药情况个体化制定治疗方案。

Objective To investigate the distribution features of the genotypes of hepatitis B virus （HBV） and the drug resistance of HBV in Wuhan district. Methods The genotypes of HBV of 157 patients in Wuhan district were de- tected by gene sequencing. The target genotypes were from A to H, and the drug resistance points of HBV were detec- ted, namely rtL80, rtL169, rtV173, rtL180, rtA181, rtT184, rtA194, rtS202, rtM204, rtN236 and rtM250. Accord- ing to the results, HBV drug resistance of nucleoside analogues were judged. Results In 157 cases of HBV infection in the urban district of Wuhan, three kinds of HBV genotypes were detected. B-type accounted for 72.61% , while C-type accounted for 26.75%, but D-type only had 1 case （0.64%）. There were 68 cases （43.31%） of drug resistance, which B-type accounted for 70.59% and C-type accounted for 29.41%. There were no significant differences between B-type and C-type in drug resistance （χ2= 0. 379, P 〉 0.05）. There were 41 cases of Lamivudine-resistance, account- ing for 60.29% of all-resistance cases, in which B-type accounted for 73. 17% and C-type accounted for 26.83%. There were 17 cases of 204I site resistance, 6 cases of 180M ＋ 204I site resistance, 12 cases of 180M ＋204V site resist- ance and 6 cases of 180M ＋ 204V/I site resistance. There were 20 cases of Adefovir Dipivoxil resistance, accounting for 29.41% of all-resistance cases, in which B-type accounted for 75.0% and C-type accounted for 25.0%. There were 9 cases of 236T site resistance, 7 cases of 181T/V site resistance and 4 cases of 236T site combined with 181T/V site re- sistance. There were 5 cases of Entecavir resistance, accounting for 7.35% of all-resistance cases. There were 3 cases of B-type and 2 cases of C-type. There were 2 cases of Lamivudine and Adefovir combination drug resistance, account- ing for 2.94% of all-resistance cases, and all of them were C-type. The results of Telbivudine-resistant and other nucle- oside analogues resistance were repetitive, totally 32 cases, accounting for 47.06% , B-type accounted for 75.0% and C-type accounted for 25.0%. Conclusion Of the 157 cases in Wuhan district, more men were infected HBV. Themajor genotype of HBV infection is B-type, C-type following. Lamivudine, Telbivudine and Adefovir Dipivoxil are main resistance. Clinic should be based on HBV genotypes and drug resistance in patients with individualized treatment plan.