目的 分析金华地区慢性乙型肝炎患者HBV基因型分布特征及HBV耐药基因位点突变情况,并探讨两者的关系.方法 选取1 04例经核苷(酸)类似物治疗的慢性乙型肝炎患者为研究对象,采用Sanger双脱氧法测序技术检测患者血清HBV的基因型和10种常见的HBV P区耐药基因位点突变情况,并分析两者关系.结果 本组慢性乙型肝炎患者中,HBV B基因型占46.15％,C基因型占53.85％,未发现其他基因型.检测出发生耐药基因位点突变61例,突变率为58.65％,其中C基因型占65.57％,B基因型占34.43％.HBV P区耐药基因位点突变率最高的为M204V/I(73.85％),其次为L180M(36.92％)和A181V/T(23.08％).HBV P区耐药基因发生单位点突变的占50.82％,其中M204I突变类型最多(29.51％);发生多位点突变的占49.18％;以M204I和M204V/I“180M两种突变类型最常见.HBV C基因型的患者耐药基因突变率高于B基因型的患者(71.43％ vs 43.75％,P＜0.05),其中C基因型的患者A181V/T位点突变率高于B基因型的患者(14.29％ vs 2.08％,P＜0.05).结论 金华地区慢性乙型肝炎患者HBV基因型以B、C基因型为主;HBV P区耐药基因位点突变类型以M204I和M204V/I+L180M两种类型最常见;HBV C基因型的患者比B基因型的患者更易发生耐药突变,且更易发生A181V/T位点突变.%Objective To analyze genotypes and mutation patterns of HBV gene in chronic hepatitis B patients in Jinhua.Methods One hundred and four patients with chronic hepatitis B who were treated with nucleoside analogues,were enrolled in the study.Sanger sequence analysis of HBV genotypes and 10 common sites of HBV P region were performed.Results There were 46.15％ cases of B genotype and 53.85％ of C genotype among 104 chronic hepatitis B patients.Other genotypes were no detected.HBV P gene mutation were detected in 61 cases (58.65％);there was 65.57％ in HBV C genotype and 34.43％ in B genotype.M204V/I was the most common site of HBV P gene mutation (73.85％),followed by L180M (36.92％) and A181V/T (23.08％).50.82％ cases had single site mutation and the most mutation pattern was M204I (29.51％);and 49.18％ had multiple sites mutation;the most common mutation patterns were M204I and M204V/I+L180M.The resistance mutation rate in C genotype was higher than that in B genotype(71.43％ vs 43.75％,P＜0.05) and the mutation rate of A181V/T in C genotype cases was higher than that in B genotype cases (14.29％ vs 2.08％,P＜0.05).Conclusion Genotype B and C are the main genotypes of HBV in this study.The most common mutation patterns of HBV P gene were M204I and M204V/I+L180M.Genotype C patients had more mutations than genotype B and the A181V/T mutation pattern was more common in genotype C.
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