拉米夫定抗HBV治疗过程中HBV-DNA的反弹规律及变异研究

Study of rebound regularity and variation of HBV-DNA during lamivudine against hepatitis B virus

目的 观察拉米夫定抗HBV治疗过程HBV DNA的反弹规律及变异情况。方法 单一采用拉米夫定 (1 0 0mg/d)治疗 83例有活动性病毒复制的慢性乙型肝炎患者 (CHB) ,应用荧光全定量PCR检测CHB治疗前和治疗 2、6、1 2、1 8个月后血清HBV DNA的含量 ,应用UniArray技术检测YMDD位点突变。结果 根据HBV DNA含量的下降、波动、反弹分 3种类型 :A类 2 8例 ,HBV DNA含量呈直线下降 ,无HBV基因突变 ;B类 2 3例 ,HBV DNA含量先下降、后反弹、波动、再下降 ,无HBV基因突变 ;C类 32例 ,HBV DNA含量先下降、后反弹、波动、再持续上升 ,有 2 7例HBV基因突变 ,其中YIDD突变 1 0例 ,YVDD突变 1 4例 ,YIDD和YVDD同时突变 3例。结论 拉米夫定抗HBV DNA治疗 2个月左右疗效十分显著 ;2至 6个月HBV DNA含量呈低水平波动 ;6至 1 2个月易出现反弹、波动 ;1 2个月后变异株形成趋势明显。

Objective To investigate rebound regularity and mutation of HBVDNA during lamivudine against hepatitis B virus. Methods 83 patients with active HBV replication were treated by lamivudine. Contents of serum HBVDNA before treatment and 2.6.12.18 monthes after treatment were determined by PCR Fluorescense quantity.HBV gene mutation were determined by Uniarray technique. Results 83 patients were devided into A,B and C groups according to descent,fluctuation and rebounding of HBVDNA contents.There are 28 cases in group A, contents of HBVDNA were linear descent and un gene mutation. There were 23 cases in group B, contents of HBVDNA first descended, then rebounded,fluctuated and descended again. The group had not gene mutation too. There were 32 cases in group C, contents of HBVDNA first descended, then rebounded,fluctuated and continuously descended. There were 27 cases with gene mutation. 10 cases belonged to YIDD mutation, 14 cases belonged to YVDD mutation, 3 cases belonged to YIDD and YVDD co mutation. Conclusion The therapeutic efficacy of lamivudine against HBVDNA in two monthes was very good. Contents of HBVDNA undulated slightly from 2 to 6 monthes. The tendency of rebounding and undulation of HBVDNA were obvious from 6 to 12 monthes. The mutation rate of YMDD raised gradually 12 monthes after treating