摘要
目的探讨拉米夫定治疗慢性乙型肝炎期间乙型肝炎病毒(HBV)YMDD变异的情况及其与临床的关系。方法采用通用模板信号扩增(UT-PCR)方法,对拉米夫定治疗过程中血清出现HBV DNA由阴转阳的52例慢性乙型肝炎患者进行HBVYMDD变异检测,并结合患者治疗前HBV DNA载量、丙氨酸转氨酶(ALT)水平、免疫标志物及YMDD变异后HBV DNA载量等临床信息进行结果分析。结果YMDD变异的检出率为53.85%,52例患者中,28例发生了YMDD变异,其中YIDD17例,YVDD7例,YIDD和YVDD混合变异4例。发生YIDD变异的患者较治疗前HBV DNA水平显著降低(P<0.05),发生YVDD变异的患者较治疗前HBV DNA水平差异无统计学意义(P>0.05)。YVDD变异后的HBVDNA水平与YIDD变异后HBV DNA水平差异无统计学意义(P>0.05)。YMDD变异组治疗前的ALT基础水平高于YMDD野生组治疗前水平(P<0.01),治疗前HBVDNA水平及HBeAg阳性率在变异组和野生组中差异无统计学意义(P>0.05)。结论拉米夫定治疗前ALT基础水平高可能是YMDD变异的一个易发因素。密切监控慢性乙型肝炎患者的HBV DNA及ALT水平,有利于及时发现YMDD是否发生变异。
Objective To study the relationship between YMDD mutation in hepatitis B virus with the levels of ALT,HBV DNA and HBeAg.Methods Fifty-two specimens of serum from chronic hepatitis B patients receiving lamivudine monotherapy were detected by UT-PCR,and the information about the HBV DNA load,the level of ALT,immune markers before the treatment and HBV DNA load after YMDD mutation were analyzed.Results The rates of HBV YMDD mutation was 53.85% （28 patients,including YIDD mutation 17 patients,YVDD mutation 7 patients and mixed mutation 4 patients）.There were significant differences between before treatment and after mutation for HBV DNA level in YIDD mutation patients（P〈0.05）,however there were no differences in YVDD mutation patients（P〈0.05）.And there were no differences in HBV DNA level between YIDD and YVDD mutation patients after mutation （P〈0.05）.ALT level before lamivudine treatment was higher in mutation type than wild type （P〈0.05）,however there were no differences for the level of HBV DNA and HBeAg between mutation type and wild type before lamivudine treatment.Conclusion The patients with high ALT levels before lamivudine treatment are at high risk of YMDD mutation.Therefore,keeping tabs on the level of HBV DNA and ALT in hepatitis B patients may be helpful to confirm YMDD mutation.
出处
《实用医技杂志》
2010年第4期301-303,共3页
Journal of Practical Medical Techniques
