拉米夫定治疗慢性乙型肝炎过程中的YMDD变异及其临床意义

YMDD mutation in therapeutic course of hepatitis B virus with Lamivudine and its clinical significance

目的 探讨拉米夫定在慢性乙型肝炎 (CHB)治疗过程中的HBV变异及其临床意义。方法 86例CHB用拉米夫定治疗 (10 0mg ,1/d ,共治疗 10 4周 )。观察SB、ALT、凝血酶原活动度 (PA)、HBeAg、抗 -HBc和YMDD变异情况。 结果 治疗 5 2周和 10 4周 ,YMDD变异率分别为 11.6%和 3 0 .2 % ,变异者ALT >40U·L-1,未变异者ALT保持正常 ,无反复 ;有 6例在停药后 2 0～ 45d ,发生重症肝炎 ,但血清中未测出YMDD变异株。结论 随服用拉米夫定时间延长 ,变异率升高 。

Objective To explore the effect of Lamivudine on the mutation of hepatitis B virus(HBV) and its clinical significance.Mothods Eight six patients with chronic hepatitis were treated with Lamivudine 100?mg a day for 104 weeks,and their serum SB, ALT, PA, HBeAg, Anti-HBe levels and YMDD mutation were investigated.Results YMDD mutation rates after 52 and the 104 weeks were 11.6% and 30.2% respectively,and the serum ALT level was different between patients with and without YMDD mutation(>40?U·L -1 and <40?U·L -1 ).In 72 weeks,HBeAg got negative and ante-HBe appeared in patients without YMDD mutation but it happened in 6 cases of severe hepatitis in 51～78 weeks.Condusion YMDD mutation rate of HBV is associated with Lamivudine therapeutic time and dosage,but no association with severe hepatitis happening after the withdrawal of Lamivudine.