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目的了解乙型肝炎病毒(HBV)逆转录酶区N236T单独突变患者与逆转录酶区N236T+A181T联合突变患者核苷(酸)类药物应用情况和病毒学特点的异同。方法对发生HBV逆转录酶区N236T单独突变与逆转录酶区N236T+A181T联合突变的慢性乙型肝炎患者的血清HBsAg、HBVDNA和丙氨酸转氨酶(ALT)水平进行检测和HBV基因分型,并对所有患者的核苷(酸)类药物治疗史进行回顾性调查。结果逆转录酶区N236T单独突变组与逆转录酶区N236T+A181T联合突变组相比较,两者血清HBsAg水平的差异无统计学意义(P=0.9755),但后者血清HBVDNA(P=0.0014)和ALT(P=0.0032)水平高于前者。此外,C型较B型容易发生rtN236T+rtA181T联合突变(40%vs20.45%,P=0.0235),由拉米夫定换用阿德福韦的治疗方式容易引起病毒突变。结论 HBV逆转录酶区N236T单独突变患者与逆转录酶区N236T+A181T联合突变患者在引起突变的核苷(酸)类药物的使用情况上存在一致性(拉米夫定换用阿德福韦),但基因型构成和血清病毒学指标存在明显差异。
Objective To find out the similarities and differences between the application of nucleoside (acid) drugs in patients with N236T mutation of HBV reverse transcriptase region and N236T + A181T mutation in reverse transcriptase region. Methods Serum levels of HBsAg, HBVDNA and alanine aminotransferase (ALT) in patients with chronic hepatitis B who had a mutation of N236T in HBV reverse transcriptase region and N236T + A181T in reverse transcriptase region were detected and HBV genotypes were analyzed. A retrospective review of all patients on the history of nucleoside (acid) drug therapy. Results There was no significant difference in serum HBsAg level between N236T mutation group and N236T + A181T mutation group in reverse transcriptase region (P = 0.9755), but serum HBVDNA (P = 0.0014) And ALT (P = 0.0032) were higher than the former. In addition, C-type compared with B-prone rtN236T rtA181T mutation (40% vs20.45%, P = 0.0235), the treatment of lamivudine switch to adefovir easily lead to virus mutations. Conclusions There is consistency in the use of nucleoside (acid) drugs that cause mutations in patients with N236T single mutation of HBV reverse transcriptase region and N236T + A181T mutation of reverse transcriptase region (lamivudine switch to adefovir ), But the genotypes and serum virological indicators there are significant differences.