武汉市乙型肝炎病毒基因型分布和 P区耐药突变模式及两者相关性分析

摘要

Objective To study the distribution of hepatitis B virus (HBV) genotypes and its correlation with the mutation patterns in the P region of HBV .Methods HBV DNA was extracted for conducting PCR .Then the HBV genotypes and P region drug resistance mutation sites were detected by using the direct sequencing method and the detection results were statistically analyzed by using the SPSS 19 .0 software .Results Among 219 patients with chronic hepatitis B ,135 cases(61 .6% ) of HBV genotype B ,61 cases(27 .9% ) of genotype C ,2 cases (0 .9% ) of gen‐otype D ,3 cases (1 .4% ) of genotype B+C ,1 case(0 .4% ) of genotype B+F+G and 17 cases (7 .8% ) of undefined genotype were detected out .Among them ,76 cases developed the drug resistance mutation ,the mutation sites were mainly M204I(42 .9% ) ,M204V(22 .1% ) and L180M(27 .3% ) .The occurrence rate of YMDD mutation had no sta‐tistically significant difference between the gynotype B and C (P>0 .05) .But in the YMDD mutation patterns ,M204I and M204V had statistical difference in the distribution of C and D genotypes (P<0 .05) .Conclusion The HBV gen‐otypes in Wuhan are mainly genotype B and C .The major drug resistant mutations are M204I ,M204V and L180M . Clinical doctors should select the proper therapeutical scheme for treating chronic hepatitis B based on the results of the genotyping and drug‐resistant mutations .%目的：探讨武汉地区乙型肝炎病毒（HBV ）基因型的分布情况和P区耐药突变模式及两者的相关性。方法提取 HBV‐DNA进行聚合酶链反应（PCR）扩增后以直接测序法检测 HBV基因型及P区耐药突变位点，用SPSS19．0软件进行统计学分析。结果219例慢性乙型肝炎患者血浆中检出 HBV基因型B型135例（61．6％）、C型61例（27．9％）、D型2例（0．9％）、B＋ C混合型3例（1．4％）、B＋ F＋ G 混合型1例（0．4％）、未分型17例（7．8％）。对202例分出基因型的标本进行耐药突变检测，其中76例发生耐药突变，突变位点以M204I（42．9％）、M204V（22．1％）、L180M（27．3％）多见。YMDD突变的发生率在B、C基因型之间比较差异无统计学意义（P＞0．05），但YMDD突变类型中的 M204V 和 M204I在B、C基因型中的分布比较差异有统计学意义（P＜ 0．05）。结论武汉地区HBV基因型以B型和C型为主，HBV耐药突变以M204I、M204V、L180M多见，临床医生应根据基因分型和耐药突变结果为慢性乙型肝炎患者选择适合的治疗方案。