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目的探讨拉米夫定(LAM)耐药慢性乙型肝炎(CHB)患者多聚酶区序列突变特点。方法收集63例接受拉米夫定治疗且耐药的CHB患者的临床资料,采用PCR产物直接测序法检测HBVP基因多聚酶区序列耐药变异。结果 63例诊断为耐药的患者中,51例患者检测到LAM相关的HBV多聚酶区基因突变,其中rtM204V/I变异46例(73.0%),rtL180M变异25例(39.7%),rtV173L/M变异5例(7.9%),rtQ214E变异1例(1.6%),rtS213T变异2例(2.%)12,rtV207L/M/I变异2例(3.2%),rtA181T变异3例(4.8%),rtT184I/S/M变异1例(1.6%)。结论对拉米夫定治疗患者的耐药检测除HBV多聚酶区常见的rtLl80M和rtM204V/I位点变异外,还应考虑其他位点的耐药变异。
Objective To investigate the mutation of polymerase chain in patients with lamivudine (LAM) -resistant chronic hepatitis B (CHB). Methods The clinical data of 63 CHB patients who were treated with lamivudine and were resistant were collected. The drug resistance variation of HBVP gene polymerase chain reaction was detected by direct sequencing of PCR products. Results Of the 63 patients diagnosed as drug resistant, LAM-related HBV polymerase gene mutations were detected in 51 patients, including rtM204V / I mutation in 46 cases (73.0%), rtL180M mutation in 25 cases (39.7%), rtV173L / M mutation There were 2 cases of rtV217T mutation (2%), 2 cases of rtV207L / M / I mutation (3.2%), 3 cases of rtA181T mutation (4.8%), rtT184I mutation / S / M mutation in 1 case (1.6%). Conclusion In addition to the common mutations of rtLl80M and rtM204V / I in HBV polymerase, the drug resistance of patients treated with lamivudine should consider the drug resistance variation of other sites.