中华传染病杂志
中華傳染病雜誌
중화전염병잡지
CHINESE JOURNAL OF INFECTIOUS DISEASES
2009年
6期
348-351
,共4页
肝炎病毒,乙型%变异(遗传学)%拉米夫定%肝炎,乙型,慢性%寡核苷酸序列分析
肝炎病毒,乙型%變異(遺傳學)%拉米伕定%肝炎,乙型,慢性%寡覈苷痠序列分析
간염병독,을형%변이(유전학)%랍미부정%간염,을형,만성%과핵감산서렬분석
Hepatitis B virus%Variation(genetics)%Lamivudine,Hepatitis B,chronic Oligonucleotide array sequence analysis
目的 研究在拉米夫定治疗慢性乙型肝炎的过程中出现拉米夫定耐药突变相关的慢性重型乙型肝炎的临床特点.方法 回顾性分析27例在拉米夫定治疗过程中出现耐药突变的慢性重型乙型肝炎病例,分析其临床特征,用基因芯片法或基因测序法检测YMDD突变类型,对8例施行肝移植术后的离体肝组织分析其病理特点.采用χ2检验进行统计学分析.结果 27例拉米夫定耐药患者的YMDD突变类型分别为:YVDD突变5例,YVDD突变+L180M突变2例,YIDD突变13例,YIDD+L180M突变4例,YVDD突变+YIDD突变1例,YVDD突变+Y1DD突变+L180M突变2例,单独L180M突变未检出.根据治疗前是否存在肝硬化,分为肝硬化组和非肝硬化组.与肝硬化组相比,非肝硬化组慢性重型乙型肝炎的发生率低,预后好,年龄小,HBeAg阳性率高.8例离体肝组织病理分析显示两种主要病理类型,一种主要表现为活动性肝硬化,另一种为大块或亚大块坏死,肝脏显著萎缩.结论 肝硬化为拉米夫定耐药突变相关的慢性重型乙型肝炎的高危因素.拉米夫定耐药突变相关的慢性重型乙型肝炎可能存在两种发病机制.
目的 研究在拉米伕定治療慢性乙型肝炎的過程中齣現拉米伕定耐藥突變相關的慢性重型乙型肝炎的臨床特點.方法 迴顧性分析27例在拉米伕定治療過程中齣現耐藥突變的慢性重型乙型肝炎病例,分析其臨床特徵,用基因芯片法或基因測序法檢測YMDD突變類型,對8例施行肝移植術後的離體肝組織分析其病理特點.採用χ2檢驗進行統計學分析.結果 27例拉米伕定耐藥患者的YMDD突變類型分彆為:YVDD突變5例,YVDD突變+L180M突變2例,YIDD突變13例,YIDD+L180M突變4例,YVDD突變+YIDD突變1例,YVDD突變+Y1DD突變+L180M突變2例,單獨L180M突變未檢齣.根據治療前是否存在肝硬化,分為肝硬化組和非肝硬化組.與肝硬化組相比,非肝硬化組慢性重型乙型肝炎的髮生率低,預後好,年齡小,HBeAg暘性率高.8例離體肝組織病理分析顯示兩種主要病理類型,一種主要錶現為活動性肝硬化,另一種為大塊或亞大塊壞死,肝髒顯著萎縮.結論 肝硬化為拉米伕定耐藥突變相關的慢性重型乙型肝炎的高危因素.拉米伕定耐藥突變相關的慢性重型乙型肝炎可能存在兩種髮病機製.
목적 연구재랍미부정치료만성을형간염적과정중출현랍미부정내약돌변상관적만성중형을형간염적림상특점.방법 회고성분석27례재랍미부정치료과정중출현내약돌변적만성중형을형간염병례,분석기림상특정,용기인심편법혹기인측서법검측YMDD돌변류형,대8례시행간이식술후적리체간조직분석기병리특점.채용χ2검험진행통계학분석.결과 27례랍미부정내약환자적YMDD돌변류형분별위:YVDD돌변5례,YVDD돌변+L180M돌변2례,YIDD돌변13례,YIDD+L180M돌변4례,YVDD돌변+YIDD돌변1례,YVDD돌변+Y1DD돌변+L180M돌변2례,단독L180M돌변미검출.근거치료전시부존재간경화,분위간경화조화비간경화조.여간경화조상비,비간경화조만성중형을형간염적발생솔저,예후호,년령소,HBeAg양성솔고.8례리체간조직병리분석현시량충주요병리류형,일충주요표현위활동성간경화,령일충위대괴혹아대괴배사,간장현저위축.결론 간경화위랍미부정내약돌변상관적만성중형을형간염적고위인소.랍미부정내약돌변상관적만성중형을형간염가능존재량충발병궤제.
Objective To study the characteristics of lamivudine-resistant mutation associated chronic severe hepatitis B during lamivudine treatment.Methods Twenty-seven patients with lamivudine-resistant mutation associated chronic severe hepatitis B during lamivudine treatment were analyzed retrospectively.YMDD motif mutation was detected by gene chips or DNA sequencing.The pathological features of liver tissues from 8 patients undergoing liver transplantation were analyzed.The X2 test were used to perform the stafistical analysis.Results The YMDD motif mutations of 27 lamivudine-resistant patients were 5 cases of YVDD mutation,2 of YVDD+L180M,13 of YIDD mutation,4 of YIDD+L180M,1 of YVDD+YIDD mutations,2 of YVDD+YIDD+L180M,and there was no single L180 M mutation among patients.Twenty-seven patients were divided into cirrhotic group and noncirrhotic group according to whether they were diagnosed with cirrhosis before treatment.Compared to cirrhotic group,incidence of severe hepatitis was lower,prognosis was better,the age of patients was younger and hepatitis Be antigen(HBeAg)positive rate was higher in noncirrhotic group.There were two types of pathological features of liver tissues from 8 patients,which were active hepatic cirrhosis and massive or submassive hepatic necrosis with liver shrinking significantly.Conclusions Hepatic cirrhosis is a risk factor of lamivudine-resistant mutation associated chronic severe hepatitis B.There may be two mechanisms in lamivudine-resistant mutation associated chronic severe hepatitis B.
