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目的观察2010年舟山某医院拉米夫定单药治疗无良好应答的乙肝患者其基因型和P区耐药位点突变的关系。方法随机选取舟山某医院就诊的124例拉米夫定单药治疗无良好应答的本地乙肝患者,男64例,女60例,平均年龄(46.92±15.16)岁,用实时荧光定量PCR检测其基因型和HBV-DNA,并用毛细管电泳测序技术对P区进行突变位点检测。结果 124例患者35例(28.23%)B型和89例(71.77%)C基因型。C型HBV-DNA为(5.83±0.91)log10 copies/mL,高于B型的(5.07±1.13)log10 copies/mL,差异具有统计学意义(t=3.55,P<0.01)。拉米夫定在B基因型中的耐药率为45.71%(16/35),低于C基因型的65.17%(58/89),差异具有统计学意义(2χ=3.951,P<0.05)。拉米夫定耐药株在B基因型中rtM204 I/V/S位点突变率为68.75%(11/16),高于C基因型的37.93%(22/58),差异具有统计学意义(2χ=4.821,P<0.05)。结论对于本地区拉米夫定治疗无良好应答的C基因乙肝患者,应加强拉米夫定的耐药位点筛查,而拉米夫定治疗无良好应答的B基因乙肝患者应加强rtM204 I/V/S位点检测。
Objective To observe the relationship between genotypes and mutations in drug resistance sites in hepatitis B patients who did not respond well to lamivudine monotherapy in a hospital in Zhoushan in 2010. Methods Totally 124 local patients with hepatitis B who did not respond well to lamivudine monotherapy were selected from a hospital in Zhoushan. There were 64 males and 60 females, with an average age of (46.92 ± 15.16) years old. The genotypes were detected by real-time fluorescence quantitative PCR And HBV-DNA, and the P region was detected by capillary electrophoresis sequencing. Results Of the 124 patients, 35 (28.23%) had type B and 89 (71.77%) had genotype C. (5.83 ± 0.91) log10 copies / mL for type C HBV DNA and (5.07 ± 1.13) log10 copies / mL for type B HBV DNA. The difference was statistically significant (t = 3.55, P <0.01). The resistance rate of Lamivudine in B genotype was 45.71% (16/35), which was lower than 65.17% (58/89) in C genotype, the difference was statistically significant (2χ = 3.951, P <0.05) . The mutation rate of rtM204 I / V / S locus in lamivudine resistant strains was 68.75% (11/16) in B genotype, which was higher than 37.93% (22/58) in C genotype, the difference was statistically significant (2χ = 4.821, P <0.05). Conclusions Lamivudine should be screened for resistance to hepatitis C in patients with hepatitis C who do not respond well to lamivudine therapy in this region, whereas hepatitis B patients with no response to lamivudine should be given enhanced rtM204 I / V / S site detection.