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目的探讨新疆和田地区维吾尔族和汉族慢性乙型肝炎(CHB)患者耐药性差异。方法随机选取2015年3月~2016年1月收治的接受拉米夫定(LAM)和/或阿德福伟(ADV)治疗的CHB患者1288例,其中维吾尔族1218例,汉族70例。采用DNA微阵列芯片技术检测血清HBV rtL180M、rtM204I/V、rtA181T/V和rtN236T四个耐药突变位点。结果汉族CHB患者HBV基因型耐药比例为25.7%,显著高于维吾尔族患者的18.3%(P=0.014);维吾尔族CHB患者男女比例为1019/199,汉族为57/13,两组性别比无显著性差异(P=0.087),但在耐药基因阳性者中,维吾尔族男性比例显著高于汉族(P=0.039);在基因型耐药患者中,维吾尔族CHB患者血清HBV DNA水平为(5.3±0.9)lg copies/ml,显著低于汉族患者的(6.1±0.7)lg copies/ml,差异有统计学意义(P=0.012);维吾尔族基因耐药患者血清ALT水平为(157.6±25.9)U/L、AST为(67.1±13.2)U/L、TBIL为(41.8±11.6)μmol/L,均显著低于汉族[分别为(203.7±45.1)U/L、(85.9±22.7)u/L、(57.4±13.5)μmol/L,差异均有统计学意义(P<0.05或P<0.01)];维吾尔族患者和汉族患者年龄分别为(37.9±10.8)岁和(38.8±12.1)岁,无明显差异(P>0.05);维吾尔族和汉族患者血清HBe Ag阳性率分别为14.3%和18.6%,无明显差异(P=0.061);在241例维吾尔族和汉族基因型耐药患者中,均检测出LAM和DAV的4个耐药变异位点的6种突变,分别为rtL180M、rtM204I、rtM204V、rtA180T、rtA180V和rtN236T;维吾尔族和汉族患者rtA1181T/V点位阳性率分别为18.4%和16.7%(P>0.05),而维吾尔族患者rtA1181T/V点位阳性率显著高于汉族患者,差异有统计学意义(P<0.05);维吾尔族和汉族患者rtL180M、rtM204I/V、rtN236T点位阳性率分别为38.6%和38.9%、27.4%和27.8%、15.7%和16.7%,差异无统计学意义(P>0.05)。结论汉族患者存在HBV基因耐药比例更高,维吾尔族男性变异比例显著高于汉族,汉族患者出现变异时血清HBV DNA、ALT、AST、TBIL水平更高,两组患者在rtA181T/V位点存在显著性差异,其他位点未见明显差异。
Objective To investigate the differences of drug resistance in Uygur and Han patients with chronic hepatitis B (CHB) in Hetian area of Xinjiang. Methods A total of 1288 CHB patients receiving lamivudine (LAM) and / or adefovir (ADV) were enrolled from March 2015 to January 2016, including 1218 Uygur and 70 Han patients. DNA microarray technique was used to detect four drug-resistant mutation sites of HBV rtL180M, rtM204I / V, rtA181T / V and rtN236T. Results The prevalence of HBV genotype in CHB patients was 25.7% in Han nationality, which was significantly higher than that in Uyghur ethnicity patients (18.3%) (P = 0.014). The Uygur ethnic CHB patients were 1019/199 in male and 57/13 in Han nationality, (P = 0.087). However, the proportion of male Uighur men was significantly higher than that of Han ethnicity (P = 0.039). In genotype-resistant patients, the level of serum HBV DNA in Uighur CHB patients was (5.3 ± 0.9) lg copies / ml, which was significantly lower than that of Han patients (6.1 ± 0.7) lg copies / ml (P = 0.012). The level of serum ALT in Uighur- (41.9 ± 11.6) μmol / L, which were significantly lower than those in Han nationality [(203.7 ± 45.1) U / L and (85.9 ± 22.7) (57.4 ± 13.5) μmol / L, respectively, with statistical significance (P <0.05 or P <0.01). The Uygur patients and Han patients were (37.9 ± 10.8) years old and (38.8 ± 12.1) years old ), No significant difference (P> 0.05). The positive rate of serum HBeAg in Uygur and Han patients was 14.3% and 18.6% respectively, with no significant difference (P = 0.061). In 241 Uighur and Han genotypes, In patients, LAM and DAV were detected 4 RtA180T, rtA180V and rtN236T, respectively. The positive rates of rtA1181T / V in Uygur and Han patients were 18.4% and 16.7% (P> 0.05), respectively. The positive rates of rtA1181T / V in Uygur patients were significantly higher than those in Han patients (P <0.05). The positive rates of rtL180M, rtM204I / V and rtN236T in Uygur and Han patients were 38.6% and 38.9%, respectively %, 27.4% and 27.8%, 15.7% and 16.7%, respectively, with no significant difference (P> 0.05). Conclusions There is a higher prevalence of HBV resistance in Han patients, a significantly higher proportion of male Uighur variability than in Han nationality. Serum HBV DNA, ALT, AST and TBIL levels are higher in patients with Han ethnicity, with a presence of rtA181T / V locus Significant differences, no significant differences in other sites.