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目的探讨慢性乙型肝炎(CHB)患者在服用拉米夫定后发生YMDD变异的相关因素。方法用聚合酶链反应(PCR)荧光定量法测定CHB患者治疗前的HBV DNA,用PCR荧光定量法联合溶解曲线法和杂交探针检测YMDD变异,并对其结果进行分析。结果61例CHB患者基因型检测结果为B型27例占44.2%,C型34例占55.7%,其中22例变异者中B型为9例,占40.9%(9/22),C型13例占59.1%(13/22)。30例未变异者中B型为14例占46.7%(14/30),C型为16例占53.3%(16/30)。YMDD变异与基因型无明显相关性(χ2=0.17,P>0.05)。发生YMDD变异的22例患者在12个月和18个月发生变异的HBV DNA水平明显高于未变异组(t=2.33,P<0.05和t=4.19,P<0.01),发生YMDD变异组与未变异组之间在治疗前的血清丙氨酸氨基转移酶(ALT)、HBeAg状态、患者的病程、年龄等方面没有显著性差异。结论HBV YMDD变异与基因型之间无明显相关性;高滴度的HBV DNA(>108拷贝/毫升)是发生YMDD变异的相关因素。
Objective To investigate the related factors of YMDD mutation in patients with chronic hepatitis B (CHB) after taking lamivudine. Methods The HBV DNA of patients with CHB before treatment was determined by polymerase chain reaction (PCR) fluorescence quantitative method. The variation of YMDD was detected by PCR fluorescence quantitative method combined with lysing curve and hybridization probe, and the results were analyzed. Results The genotypes of 61 CHB patients were type B (44.2%), type C (34.7%), type B (9.9%), type C Cases accounted for 59.1% (13/22). Among the 30 cases, 14 cases were type B, accounting for 46.7% (14/30), while 16 cases were type C, accounting for 53.3% (16/30). There was no significant correlation between YMDD mutation and genotype (χ2 = 0.17, P> 0.05). The HBV DNA levels in 22 patients with YMDD mutation at 12 months and 18 months were significantly higher than those in non-mutation group (t = 2.33, P <0.05 and t = 4.19, P <0.01) There was no significant difference in serum ALT, HBeAg status, disease course and age of patients before treatment between the two groups. Conclusion There is no significant correlation between HBV YMDD mutation and genotype. High titer of HBV DNA (> 108 copies / mL) is the related factor of YMDD mutation.