某地区乙型肝炎病毒基因型分布和P区耐药突变模式分析

摘要

目的：探讨十堰地区乙型肝炎病毒（HBV）基因型分布和 P 区耐药突变模式及两者的相关性。方法将在该院进行治疗的224例慢性乙型肝炎患者纳入本研究，提取患者血液标本中的 HBV DNA ，利用 ABI 3730型遗传分析仪对 DNA 进行测序，通过 SeqMan 软件实施序列比对，分析 HBV DNA 的基因型和 P 区耐药突变的情况。结果检出 HBV 基因型为 B 型者136例，占60．71％；为 C 型者62例，占27．68％。二者比例均高于 D 型、B ＋ C 型及未分型者，差异有统计学意义（P＜0．05）。78例明确出现耐药突变，其中 B 基因型对于拉米夫定以及阿德福韦的耐药率分别为18．38％与9．56％，与 C 基因型对于二者的耐药率16．13％与9．68％相比，差异均无统计学意义（P ＞0．05）。 B 基因型患者 M204V 、M204I 耐药突变的发生率分别为38．60％、17．54％，C 基因型患者则分别为28．57％与38．10％，两种基因型患者比较差异无统计学意义（P＞0．05）。 B 、C 型基因突变患者间 YMDD 突变（M204V 、M204I）及非 YMDD 突变所占比例比较，差异均无统计学意义（P＞0．05）。 B 基因型及 C 基因型分别与M204V 及 M204I 两种突变均呈正相关。结论十堰地区 HBV 的基因型主要是 B 型及 C 型，发生的 HBV 耐药突变则以 M204I和 M204V 为主，在临床治疗时应按照基因分型以及耐药突变情况合理选择药物进行慢性乙型肝炎的治疗。%Objective To study the distribution of hepatitis B virus genotypes in Shiyan City and analyse the correlation between it and the pattern of drug resistance mutation in P district .Methods Totally 224 patients with chronic hepatitis B were enrolled in the study ,after the HBV DNA samples were extracted ,nucleotide sequencing was carried out by using ABI 3730 genetic analyzer , the sequence alignment was done by using SeqMan software .The HBV genotype and drug resistance mutation at P region of HBV DNA were analyzed .Results Genotype B was detected in 136 cases accounting for 60 .71% ;genotype C was detected in 62 cases accounting for 27 .68% .The proportion of the two were higher than those of D type ,B + C type and non‐classification cases ,the difference was statistically significant(P< 0 .05) .Totally 78 cases were confirmed to have drug resistance mutation .The drug re‐sistance rate of genotype B to lamivudine and adefovir were 18 .38% and 9 .56% respectively ,while those of genotype C were 16 .13% and 9 .68% respectively .The difference between the two genotypes was not statistically significant(P> 0 .05) .There was no significant difference among the proportion of B mutations(M204V ,M204I) and non YMDD mutation in patients(P> 0 .05) .B and C genotypes were positively correlated with M204V and M204I mutations .Conclusion The genotypes of HBV in Shiyan city were mainly B and C and the types of drug resistance mutations were mainly M204V and M204I .The therapies should be chosen ac‐cording to the genotype and drug resistance mutation .