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目的 了解深圳地区慢性乙型肝炎患者在长期拉米夫定治疗中HBV多聚酶基因YMDD变异的情况及其对治疗反应的影响。方法 对 10 0例拉米夫定治疗中 2 8例出现血清病毒核酸 (HBVDNA)阳性的患者 ,采用限制性片段长度多态性分析法 (PCR -RFLP)检测YMDD变异 ,并观察其血清HBVDNA及丙氨酸转氨酶 (ALT)水平。结果 10 0例中有 17例YMDD变异阳性 ,其中以YVDD(M5 5 0V)变异为主 ,占 64 7% (11/17) ,YIDD(M5 5 0I)变异为 3 5 3 % (6/17)。发生YMDD变异的患者均伴有HBVDNA及ALT水平反跳 ,1例住院患者停用拉米夫定后出现病情加重。结论 深圳地区慢性乙型肝炎患者在长期拉米夫定治疗中 (疗程 1年 ,10 0mg/d)HBV多聚酶基因YMDD变异率为 17 0 % (17/10 0 ) ,发生变异者较无变异者疗效降低 ,检测YMDD变异有助于监测疗效。
Objective To investigate the variation of HBV polymerase gene YMDD in patients with chronic hepatitis B in long-term lamivudine treatment and its effect on response to treatment. Methods A total of 28 patients with positive HBVDNA in lamivudine treatment were enrolled in this study. Restriction fragment length polymorphism (PCR-RFLP) was used to detect the mutation of YMDD. The serum levels of HBV DNA and Alanine aminotransferase (ALT) levels. Results Among 10 0 cases, 17 cases were positive for YMDD mutation, of which YVDD (M550V) was the major mutation, accounting for 64.7% (11/17) and YIDD (M5501) was 353% (6/17 ). Patients with YMDD mutations were associated with a rebound in HBVDNA and ALT levels, and one hospitalized patient exacerbated after lamivudine discontinuation. Conclusion The mutation rate of YMDD of HBV polymerase gene in chronic hepatitis B patients in long-term lamivudine treatment (1 year of treatment, 100 mg / d) was 17 0% (17/10 0) in Shenzhen. Compared with those without mutation Efficacy decreased, detection of YMDD mutation helps monitor the effect.