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目的分析拉米夫定耐药株感染者的基因型、HBV DNA及多聚酶P区基因变异的关系。方法应用PCR扩增和直接测序法检测83例拉米夫定耐药患者HBV基因型、HBV DNA及多聚酶P区的基因变异。结果 83例拉米夫定耐药患者B基因型26例,C基因型57例,B型YIDD变异率69.2%(18/26)、YVDD变异率30.8%(8/26),C型YIDD变异率63.2%(36/57)、YVDD变异率33.3%(19/57),B、C基因型发生YMDD变异模式无统计学差异(P>0.05);B型rtM204I突变率53.8%(14/26),综合变异率46.2%(12/26),C型rtM204I变异率26.7%(15/57),综合变异率73.7%(42/57),B、C基因型变异位点类型有统计学差异(P<0.05);耐药变异时C型HBV DNA水平(6.60±1.42)lg拷贝/毫升高于B型(5.88±1.46)lg拷贝/毫升,YIDD变异时C型(6.40±1.48)lg拷贝/毫升、B型(5.68±1.32)lg拷贝/毫升,YVDD变异时C型(6.18±1.87)lg拷贝/毫升、B型(6.82±1.45)lg拷贝/毫升;rtM204I变异时B型(6.12±1.45)lg拷贝/毫升、C型(5.57±1.45)lg拷贝/毫升(P>0.05);综合变异时C型(6.68±1.51)lg拷贝/毫升,B型(5.76±1.57)lg拷贝/毫升(P<0.05)。结论 C基因型拉米夫定耐药发生率高于B型;基因型与变异位点类型有关,与YMDD变异模式无关;耐药变异时HBV DNA水平C型高于B型,与综合变异有关,与YMDD变异模式无关。
Objective To analyze the genotypes, HBV DNA and the variation of polymerase chain-P (P-region) in patients infected with lamivudine-resistant strains. Methods The genotypes of HBV, HBV DNA and polymerase chain-P in 83 lamivudine-resistant patients were detected by PCR amplification and direct sequencing. Results There were 26 B genotypes and 57 C genotypes in 83 patients with lamivudine resistance, the mutation rate of B YIDD was 69.2% (18/26), the mutation rate of YVDD was 30.8% (8/26), C YDD mutation (P <0.05). The mutation rate of type rtM204I was 53.8% (14/26) in patients with BVD genotype (63.2%, 36/57) and YVDD mutation rate was 33.3% (19/57) ), The overall mutation rate was 46.2% (12/26), the mutation rate of C rtM204I was 26.7% (15/57), and the comprehensive mutation rate was 73.7% (42/57). There were significant differences in the types of B and C genotypes (6.60 ± 1.42) lg copies / ml was higher than that of B (5.88 ± 1.46) lg copies / ml when the drug resistance was changed, and C (6.40 ± 1.48) lg copies were YIDD mutation / Ml, type B (5.68 ± 1.32) lg copies / ml, type C (6.18 ± 1.87) lg copies / ml for type YVDD, type B (6.82 ± 1.45) (P <0.05); C (6.68 ± 1.51) lg copies / ml, B (5.76 ± 1.57) lg copies / ml (P <0.05). Conclusion The incidence of lamivudine resistance in genotype C is higher than that in genotype B. The genotypes are related to the types of mutation sites and have no relation with YMDD mutation patterns. The level of HBV DNA in genotype C is higher than that in genotype B, , Has nothing to do with the YMDD mutation pattern.