目的：研究感染乙型肝炎病毒患者的乙型肝炎病毒 e 抗原（HBeAg）转阴与长期应用拉米夫定诱发的YMDD 变异和病毒基因型的相关性。方法选取本院确诊的慢性乙型肝炎患者1200例，其中 HBeAg 血清学转阴患者577例，未转阴患者623例，检测患者 HBeAg 、乙型肝炎病毒脱氧核糖核酸（HBV-DNA ）和 HBV 基因型，并比较和探讨3者的关系。结果577例 HBeAg 阴性患者中有233例（40．38％）存在病毒复制（HBV-DNA ≥103）；对233例基因分型显示，A 、B 、C 、D 基因型分别为163例（69．96％）、57例（24．46％）、11例（4．72％）、2例（0．86％）；YMDD 突变检测发现，233例患者中106例（45．49％）发生 YMDD 突变，其中Ⅴ突变68．87％，Ⅰ突变22．64％，Ⅰ/Ⅴ共生突变8．49％。在106例 YMDD 突变患者中 A 、B 、C 、D 基因型分别为0例（0．00％）、72例（67．92％），27例（25．47％），7例（6．60％）。结论本院所在地区 HBeAg 血清转阴的慢性乙型肝炎患者病毒复制仍保持一定的活力，持续监测病毒拷贝数、YMDD 突变和基因型对于此类患者治疗非常必要。%Objective To study the correlation between hepatitis B e antigen (HBeAg)-negative and HBV gen-otype ,YMDD mutation induced by long-term use of lamivudine in patients with hepatitis B virus infection .Methods 1 200 patients with chronic hepatitis B were recruited in this study ,of which 577 patients were HBeAg negative and 623 were HBeAg positive .Enzyme-linked immunoadsordent assay(ELISA) ,Taqman QPCR and linear probe hybrid-ization were used to detect HBeAg 、HBV-DNA and HBV genotypes respectively .And the relationships between them were analyzed .Results There were 233 patients(40 .38% )with HBV-DNA virus replication (HBV-DNA ≥ 103 ) in all the 577 HBeAg-negetive patients .Further genotyping results showed that there were 163 (69 .96% ) ,57 (24 .46% ) ,11(4 .72% ) and 2(0 .86% ) cases in genotype A ,B ,C and D respectively .YMDD mutation test found that there was 106 cases in 233 patients(45 .49% )with YMDD mutation ,composed by Ⅴ mutation(68 .87% ) ,Ⅰ muta-tions(22 .64% ) ,and Ⅰ/Ⅴ symbiotic mutation(8.49% ) .In the 106 YMDD mutation cases there were 0(0 .00% ) ,72 (67 .92% ) ,27(25 .47% ) ,and 7(6 .60% )cases for genotype A ,B ,C and D respectively .Conclusion Replication of hepatitis B virus was somewhat exist in patients with HBeAg-negative .Continuous monitoring of HBV viruses copy number ,YMDD mutation and genotype is necessary for the treatment of these patients .
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