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目的探讨原发性肝癌患者拉米夫定治疗前后HBV YMDD变异与HBV DNA复制水平的相关性,为临床治疗提供依据。方法应用实时荧光聚合酶链反应(PCR)技术检测72例原发性肝癌患者未服用拉米夫定治疗前血清HBV DNA载量以及服用拉米夫定治疗12个月血清中YMDD突变情况。结果 72例原发性肝癌患者中,出现YMDD变异者35例(48.6%),其中YIDD变异者28例,YVDD变异者4例,YIDD和YVDD混合变异者3例。治疗后YMDD突变组HBV DNA载量显著高于YMDD野生组,拉米夫定治疗后YIDD及YIDD+YVDD杂合型的突变率明显增加,而对YVDD的突变率则有所降低。结论拉米夫定对原发性肝癌患者治疗前后HBV DNA复制水平无显著影响,而拉米夫定治疗后HBV DNA复制水平与YMDD突变具有相关性,可作为早期监测原发性肝癌HBV YMDD突变的观察指标之一。
Objective To investigate the relationship between HBV YMDD mutation and HBV DNA replication in patients with primary liver cancer before and after lamivudine treatment and provide the basis for clinical treatment. Methods Real-time fluorescence polymerase chain reaction (PCR) was used to detect the serum HBV DNA load in 72 patients with primary liver cancer before taking lamivudine and the serum YMDD mutation in 12 months after taking lamivudine. Results Of 72 patients with primary liver cancer, 35 patients (48.6%) had YMDD mutation, including 28 patients with YIDD mutation, 4 patients with YVDD mutation and 3 patients with YIDD and YVDD mutation. After treatment, the HBV DNA load of YMDD mutation group was significantly higher than that of YMDD wild group, the mutation rate of YIDD and YIDD + YVDD heterozygous after lamivudine treatment increased obviously, but the mutation rate of YVDD decreased. Conclusions Lamivudine has no significant effect on the level of HBV DNA replication in patients with primary liver cancer before and after treatment. However, the level of HBV DNA replication after lamivudine treatment is correlated with the mutation of YMDD, which may serve as an early monitoring of HBV YMDD mutation in primary liver cancer One of the observed indicators.