摘要
目的研究阿德福韦酯(ADV)初治耐药和ADV挽救治疗拉米夫定(LAM)耐药者再耐药的临床和病毒学特点。方法对ADV治疗过程中出现病毒突破的患者进行耐药位点的检测。明确耐药位点患者中单用ADV者37例,LAM耐药后换用ADV的患者40例,患者发生病毒学突破时留取血清标本,行血生化检测并收集其临床资料。结果 ADV初治耐药(ADVr)组和ADV挽救LAM耐药再耐药(LAMr/ADVr)组患者临床特征中的平均年龄、性别分布、HBsAg定量、HBV DNA载量、基因型分布、肝功能指标(TBil、ALT和AST水平)等差异均无统计学意义(P均>0.05),但两组患者的HBeAg阳性率差异具有统计学意义(57.5%vs 83.8%;χ2=6.339,P=0.012)。在病毒学特征方面,N236T变异、A181T+N236T变异更多发生于ADVr组患者中,而LAMr/ADVr组患者的耐药模式更加复杂。结论 LAM耐药后换用ADV治疗同样会导致病毒耐药的发生,临床特征和ADV初治耐药相近,但引起HBV变异模式的复杂化。
Objective To study the clinical and virological characteristics of adefovir dipivoxil （ADV） de novo resistance and ADV rescue therapy lamivudine （LAM） resistance. Methods Patients treated with ADV were detected drug resistance when occurring viral breakthrough. There were 37 ADV-na？ve patients and 40 ADV rescue LAM resistant patients enrolled in this study. Their conventional biochemical tests results and clinical data were collected. Results The average age, sex distribution, HBsAg quantiifcation, HBV DNA load, genotypes, liver function （TBil, ALT and AST levels） between the two groups showed no signiifcant difference （P all〉0.05）. The proportion of HBeAg-positive was signiifcantly different in the two groups （57.5%vs 83.8%;χ^2=6.339, P=0.012）. In virological characteristics, N236T mutation and A181T＋N236T mutation were more often seen in ADVr group, LAMr/ADVr group had more complex resistance patterns. Conclusions Switching to ADV therapy after LAM resistance could also cause the occurrence of viral resistance, the clinical characteristics were similar to ADV de novo resistance, but the HBV mutation patterns were more complex.
出处
《中华实验和临床感染病杂志（电子版）》
CAS
2014年第2期27-30,共4页
Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)
基金
国家科技重大专项子课题(No.2008ZX10002004-001-024)
关键词
病毒性肝炎
乙型
核苷(酸)类似物
耐药
变异
临床特征
Hepatitis B virus
Nucleos（t）ide analogues
Resistance
Mutation
Clinical characteristics
