150例CHB患者YMDD突变发生率与乙型肝炎病毒基因型的研究

摘要

目的 探讨浙江省嘉善地区乙型肝炎病毒基因型与拉米夫定耐药基因突变的关系及临床意义.方法 选取2010年01月至2013年12月在我院门诊和住院服用拉米夫定治疗12个月的慢性乙型肝炎(CHB)患者共150例,采用PCR-反向点杂交(RDB)法和荧光定量PCR方法检测慢性乙型肝炎患者治疗前、治疗12个月后血清标本,并进行乙肝病毒基因型分析和定量HBV DNA和YMDD突变检测.结果 HBV B亚型81例占54.00％、HBV C亚型67例占44.67％,HBV B+D混合型2例占1.33％.治疗前患者血清中检测出6例YMDD突变,均为HBV B亚型,治疗12个月后检测到YMDD突变32例,其中HBV B亚型的发生率24.69％ (20/81),HBV C亚型的发生率17.91％(12/67)两者比较差异有统计学意义(P＜0.05).结论 YMDD突变发生率与乙型肝炎病毒基因型有一定的关联.%Objective To investigate the relationship between hepatitis B virus genotype and lamivudine-resistant YMDD mutations and the clinical significance.Methods A total of 150 cases with chronic hepatitis B (CHB) were chosen from the outpatients and inpatients in our hospital.By testing the serum before and after they have taken lamivudine for 12 months,hepatitis B virus (HBV) genotype,HBV DNA quantitation,and YMDD mutation were tested applying polymerase chain reaction (PCR)-reverse dotblot (RDB) hybridization and real-time quantitative PCR.Results Of the 150 patients,81 (54.00％) were HBV subtype B;67 cases (44.67％) were HBV subtype C,and 2 cases (1.33％) were mixtures of HBV B and D.Before taking lamivudine,6 patients were found to have YMDD mutation in their serum,the genotype was HBV subtypes B.After taking lamivudine for 12 months,YMDD mutation was detected in 32 cases,of whom the proportion of HBV subtypes B was 24.69％ (20/81);the proportion of HBV subtype C was 17.91％;the difference was statistically significant (P ＜ 0.05).Conclusion The prevalence of YMDD mutation was associated with hepatitis B virus genotype.