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目的:探讨慢性乙型肝炎经过阿德福韦酯治疗后发生病毒变异情况,以指导临床治疗和预后判断。方法:利用基因测序技术对52例经阿德福韦酯治疗后发生病毒变异患者的血清进行乙肝病毒P区全序列测定,按不同变异位点分为3组(rtA181T/V位点,rtN236T位点及二者联合变异),比较三个位点变异患者用药前及发生变异后的ALT、HBVDNA变化。结果:52例阿德福韦变异患者rtA181T/V发生变异为25例,rtN236T发生变异为17例,联合变异为10例。用药前3组ALT、HBVDNA值无明显差异,P>0.05,而联合变异患者的ALT和HBVDNA值较单一变异患者要高,两者比较P<0.05。结论:慢性乙型肝炎阿德福韦酯治疗发生变异主要位点为rtA181T/V和rtN236T。当两个位点联合变异时,生化、病毒学突破更明显,提示患者临床预后可能较差。
Objective: To investigate the occurrence of virus mutation in patients with chronic hepatitis B after adefovir dipivoxil treatment to guide the clinical treatment and prognosis. Methods: The complete sequence of hepatitis B virus (HBV) P region was determined in 52 sera of patients with virus mutation after adefovir dipivoxil treatment by gene sequencing and divided into 3 groups (rtA181T / V, rtN236T Point and the combination of the two variants) were compared before and after treatment changes in patients with mutations in the ALT, HBVDNA changes. Results: There were 25 cases of rtA181T / V mutation in 52 cases of adefovir mutation, 17 cases of rtN236T mutation and 10 cases of combined mutation. There was no significant difference in the values of ALT and HBVDNA between the three groups before treatment (P> 0.05), while the ALT and HBVDNA values in patients with combined mutation were higher than those in single mutation group (P <0.05). Conclusion: Adefovir dipivoxil treatment of chronic hepatitis B major site of mutation rtA181T / V and rtN236T. When the two sites combined mutation, biochemical, virological breakthrough more obvious, suggesting that patients with clinical prognosis may be poor.