慢性乙型肝炎患者经拉米夫定治疗后YMDD突变发生情况及相关因素分析

Analysis of YMDD Mutation and the Related Factors After Treated with Lamivudine for Chronic Hepatitis B

目的:分析慢性乙型肝炎(CHB)患者经拉米夫定治疗后酪氨酸-蛋氨酸-天门冬氨酸(YMDD)突变发生情况及探讨其相关因素。方法:选取2014年1月至2016年12月期间河南省南阳市第二人民医院收治的106例CHB患者作为作为研究对象,采用回顾性分析法分析所有患者的临床资料,所有患者均予以拉米夫定治疗,且根据资料结果统计分析106例CHB患者中YMDD发生变异情况,且记录所有患者间其治疗前丙氨酸氨基转移酶(ALT)、乙型肝炎e抗原(HBeAg)状态和乙型肝炎病毒(HBV)DNA等水平,并比较不同患者间其上述资料的差异性。结果:(1)本组106例经拉米夫定治疗后的CHB患者中有58例(54.72%)发生YDMM突变,所占比例较高;(2)A组患者其主要采用拉米夫定治疗,B组采用联合治疗为主,且A组患者HBV DNA水平较高,ALT水平较低,HBeAg阳性率较高(P<0.05);(3)经非条件多因素Cox回归分析可得,治疗方式、HBV DNA和ALT水平及HBeAg的转阴率均为影响YDMM突变的独立危险因素(P<0.05)。结论:经拉米夫定治疗后的CHB患者其YDMM突变率较高,而治疗方式、HBV DNA和ALT水平及HBeAg的转阴率均为影响YDMM突变的独立危险因素。

Objective： To analyze tyrosine-methionine-aspartic acid（YMDD） mutant and its related factors after treated with lamivudine for chronic hepatitis B（CHB）. Methods： 106 CHB patients admitted to hospital from January 2014 to December 2016 and treated with lamivudine were studied on YMDD mutation and alanine aminotransferase（ALT）, Hepatitis B e antigen（HBeAg） and hepatitis B virus（HBV） DNA levels were investigated.Results：（1）58 cases（54.72%） YDMM mutation occurred in this 106 patients with CHB patients treated with lamivudine;（2）group A with only lamivudine treatment showed higher HBV DNA levels and HBeAg-positive rate, and lower ALT levels compared with group B with combined treatment（P0.05）;（3）the unconditional multivariate Cox regression analysis is available, treatment modalities, HBV DNA and ALT levels and HBeAg negative rates are independent risk factors for affecting the YDMM mutation（P0.05）. Conclusion： After treatment with lamivudine, the YDMM mutation rate is higher in patients with CHB. Treatment modalities, levels of ALT and HBeAg and HBV DNA negative rates are independent risk factors for affecting the YDMM mutation.