南京地区268例慢性HBV感染者天然耐药突变调查及影响因素分析

An investigation on natural drug resistance mutations in 268 patients with chronic hepatitis B viral infection in Nanjing

目的调查分析南京地区268例慢性乙型肝炎病毒(HBV)感染者天然耐药突变情况,并分析影响天然耐药突变发生的相关因素。方法回顾性分析2019年10月—2022年10月南京地区268例慢性HBV感染者的资料,统计天然耐药发生情况及耐药突变类型,比较发生突变和未发生突变患者临床特征,采用logistic分析影响天然耐药突变发生的因素。结果268例慢性HBV感染患者经基因测序检测,共有9例天然耐药突变,检出率为3.36%(9/268);9例天然耐药突变患者耐药位点分别为rt180M、rt204V、rt204I、rt250V、rt180M、rt204V+rt180M、rt213T、rt236T和rt204I+rt180M,发生突变患者年龄、HBV DNA水平、病程均高于未发生突变患者(P<0.05);Logistic多因素回归分析显示,年龄、HBV DNA水平、病程均是影响慢性HBV感染者发生天然耐药突变的独立危险因素(OR=4.162,4.411,5.766,P<0.05)。结论该地区慢性HBV感染者存在天然耐药突变,年龄、HBV DNA水平、病程均是影响慢性HBV感染者发生天然耐药突变的独立危险因素,应加强防范。

Objective To investigate and analyze the natural drug resistance mutations of 268 patients with chronic hepatitis B viral(HBV)infection in Nanjing,and analyze the relevant factors affecting the occurrence of natural resistance mutations to nucleos(t)ide analogues of anti-HBV drugs.Methods The data of 268 patients with chronic HBV infection in Nanjing from October 2019 to October 2022 were analyzed retrospectively.The occurrences of natural drug resistance and the types of drug resistance mutations were counted.The clinical characteristics of patients with and without mutations were compared.Logistic analysis was used to analyze the relevant factors affecting the occurrence of natural drug resistance mutations in these patients.Results In 268 patients with chronic HBV infection,a total of 9 natural drug-resistant mutations were detected by gene sequencing,the detection rate was 3.36%(9/268).The drug resistance sites of the 9 patients with natural drug resistance mutations were rt180M,rt204V,rt204I,rt250V,rt180M,rt204V+rt180M,rt213T,rt236T and rt204I+rt180M,respectively.The age,HBV DNA load,and the course of disease in patients with mutation were higher than those without mutation(P<0.05).By logistic multivariate regression analysis it was shown that age,HBV DNA level and the course of disease were independent risk factors for the occurrence of natural drug-resistant mutations in patients with chronic HBV infection(OR=4.162,4.411,5.766,P<0.05).Conclusion There are natural drug-resistant mutations in chronic HBV infected people in Nanjing area.Age,HBV DNA level,the course of disease are independent risk factors that affect the occurrence of natural drug-resistant mutations in chronic HBV infected patients,Prevention should therefore be strengthened.