目的 了解深圳地区乙肝患者HBV基因型分布情况,分析HBV基因型、耐药性与HBV DNA载量、HbeAg之间的关系.方法 用反向线性杂交技术检测156例慢性乙肝(CHB)患者的基因型和耐药突变情况,用荧光定量PCR检测其HBVDNA载量,用酶联免疫吸附法(ELISA)检测HBV病毒标志物.结果 156例CHB患者中检出B基因型90例,占57.69％；C基因型58例,占37.17％;B+C混合基因型8例,占5.13％；耐药突变37例,占23.7％.37例耐药株中,有30例对拉米夫定耐药,主要为rtL180M+ rtM204V和rtM204I突变,占80％(24/30),C基因型占拉米夫定突变株的63.3％(19/30)；对阿德福韦耐药株5例,耐药位点均为rtN236T；另有2例为多重耐药.HBV B、C基因型患者间的HBV DNA载量及HbeAg阳性率结果差异无统计学意义.结论 深圳地区HBV基因型以B、C型为主,C基因型容易产生耐药,应根据基因分型和耐药突变结果对慢性乙肝患者选择适合的治疗方案.%Objective To learn the HBV genotype distribution of hepatitis B patients in Shenzhen region and analyze the relationship among HBV genotypes resistant,HBV DNA load,and HBeAg.Methods 156 patients with chronic hepatitis B (CHB) were enrolled.The genotype and resistance mutations were detected using the methods of reverse linear hybridization,HBV DNA load was detected by quantitative PCR,and HBV virus markers were detected by enzyme-linked immunosorbent assay (ELISA).Results 90 cases were detected genotype B in 156 patients with CHB,accounting for 57.69％.58 cases were detected the C genotype,accounting for 37.17％.8 cases were detected B + C mixed genotype,accounting for 5.13％.37 cases were detected resistant mutations,accounting for 23.7 ％.30 cases were lamivudine resistance,mainly rtL180M + rtM204V and rtM204I mutations,accounting for 80 ％ (24/30).C genotype accounted for 63.3％ of lamivudine mutant strains (19/30),and 5 cases of drug-resistant strains of adefovir resistance sites are rtN236T.Two cases were multiple drug-resistant.Between HBV genotype B and C in patients with HBV DNA load and HbeAg positive results,there was no statistically significant difference.Conclusion HBV genotypes in Shenzhen area are mainly hepatitis B and C.C genotype is easy to produce drug resistance,and we should select the appropriate treatment plan according to the results of genotyping and drug resistance mutations in patients with chronic hepatitis B.
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