国际检验医学杂志
國際檢驗醫學雜誌
국제검험의학잡지
INTERNATIONAL JOURNAL OF LABORATORY MEDICINE
2009年
12期
1163-1165,1168
,共4页
张晓平%邱丽影%秦俊生%李俊祥%史冰洋
張曉平%邱麗影%秦俊生%李俊祥%史冰洋
장효평%구려영%진준생%리준상%사빙양
肝炎病毒%乙型%基因型%聚合酶链反应%寡核苷酸序列分析%拉米夫定%普查
肝炎病毒%乙型%基因型%聚閤酶鏈反應%寡覈苷痠序列分析%拉米伕定%普查
간염병독%을형%기인형%취합매련반응%과핵감산서렬분석%랍미부정%보사
Hepatitis B virus%Genotype%Polymerase chain reaction%Oligonucleotide array sequence analysis%Lamivudine Mass screening
目的 了解深圳地区乙肝病毒基因型分布特点以及拉米夫定(LMV)和阿德福韦(ADV)两种药物治疗后相关指标变化情况.方法 276例HBeAg阳性患者采用实时荧光定量PCR法检测HBV DNA的含量,免疫化学发光法检测HBeAg的相对含量,DNA反向斑点杂交芯片技术检测HBV DNA基因型与LMV常见耐药位点、ADV常见耐药位点,全自动生化测定谷丙转氨酶.随机选取未发生以上突变位点慢性病例各96例,分别以LMV和ADV两种药物进行治疗,于治疗前和治疗3、12个月检测HBV DNA、HBeAg及ALT的含量,并在治疗12个月时筛查2组耐药突变位点.结果 276例HBeAg阳性标本有270例可以进行分型,其中B型138例(50.0%)、C型96例(34.8%)、D型10例(3.6%)、B+C混合型26例(9.4%)、未分型6例(2.2%).在治疗3个月时LMV组HBV DNA与HBeAg含量下降速度和阴转率以及ALT下降明显高于ADV组(P<0.05);但在治疗第12个月时LMV组HBV DNA含量下降速度和阴转率反而低于ADV组.LMV组有20例发生耐药位点,而ADV组无一例发生位点突变.结论 深圳地区乙肝分型主要以B、C两犁为主,B型略占优势,B+C混合型也占有一定比例,核苷类药物LAM及ADV单药治疗慢性乙肝患者均有较好的疗效,但两种药物比较,短期效果LAM优于ADV,随着用药时间延长,耐药突变基因的逐渐出现,ADV长期治疗效果反而要优于LAM.
目的 瞭解深圳地區乙肝病毒基因型分佈特點以及拉米伕定(LMV)和阿德福韋(ADV)兩種藥物治療後相關指標變化情況.方法 276例HBeAg暘性患者採用實時熒光定量PCR法檢測HBV DNA的含量,免疫化學髮光法檢測HBeAg的相對含量,DNA反嚮斑點雜交芯片技術檢測HBV DNA基因型與LMV常見耐藥位點、ADV常見耐藥位點,全自動生化測定穀丙轉氨酶.隨機選取未髮生以上突變位點慢性病例各96例,分彆以LMV和ADV兩種藥物進行治療,于治療前和治療3、12箇月檢測HBV DNA、HBeAg及ALT的含量,併在治療12箇月時篩查2組耐藥突變位點.結果 276例HBeAg暘性標本有270例可以進行分型,其中B型138例(50.0%)、C型96例(34.8%)、D型10例(3.6%)、B+C混閤型26例(9.4%)、未分型6例(2.2%).在治療3箇月時LMV組HBV DNA與HBeAg含量下降速度和陰轉率以及ALT下降明顯高于ADV組(P<0.05);但在治療第12箇月時LMV組HBV DNA含量下降速度和陰轉率反而低于ADV組.LMV組有20例髮生耐藥位點,而ADV組無一例髮生位點突變.結論 深圳地區乙肝分型主要以B、C兩犛為主,B型略佔優勢,B+C混閤型也佔有一定比例,覈苷類藥物LAM及ADV單藥治療慢性乙肝患者均有較好的療效,但兩種藥物比較,短期效果LAM優于ADV,隨著用藥時間延長,耐藥突變基因的逐漸齣現,ADV長期治療效果反而要優于LAM.
목적 료해심수지구을간병독기인형분포특점이급랍미부정(LMV)화아덕복위(ADV)량충약물치료후상관지표변화정황.방법 276례HBeAg양성환자채용실시형광정량PCR법검측HBV DNA적함량,면역화학발광법검측HBeAg적상대함량,DNA반향반점잡교심편기술검측HBV DNA기인형여LMV상견내약위점、ADV상견내약위점,전자동생화측정곡병전안매.수궤선취미발생이상돌변위점만성병례각96례,분별이LMV화ADV량충약물진행치료,우치료전화치료3、12개월검측HBV DNA、HBeAg급ALT적함량,병재치료12개월시사사2조내약돌변위점.결과 276례HBeAg양성표본유270례가이진행분형,기중B형138례(50.0%)、C형96례(34.8%)、D형10례(3.6%)、B+C혼합형26례(9.4%)、미분형6례(2.2%).재치료3개월시LMV조HBV DNA여HBeAg함량하강속도화음전솔이급ALT하강명현고우ADV조(P<0.05);단재치료제12개월시LMV조HBV DNA함량하강속도화음전솔반이저우ADV조.LMV조유20례발생내약위점,이ADV조무일례발생위점돌변.결론 심수지구을간분형주요이B、C량리위주,B형략점우세,B+C혼합형야점유일정비례,핵감류약물LAM급ADV단약치료만성을간환자균유교호적료효,단량충약물비교,단기효과LAM우우ADV,수착용약시간연장,내약돌변기인적축점출현,ADV장기치료효과반이요우우LAM.
Objective To understand the distribution of hepatitis B genotypes in Shenzhen area and the changes of its indicators after lamivudine (LMV) and adefovir antiviral (ADV) treatment. Methods The content of HBV DNA was measured with real-time fluorescent RT-PCR and the relative amount of HBeAg was determined with chemiluminescent immunoassay (CLIA) in 276 patients with HBeAg positive. Reverse dot blot hybridization DNA chip method was applied to detecting HBV DNA genotypes, common LMV-resistance sites (rtl80M + rt204V + rt204I + r207I) and common ADV-resistance sites (rtA181V+rtA236T)) fully antomatic biochemical analyzer was applied to examining alanine aminotransferase (ALT). The DNAs of HBV and HBeAg as well as ALT were detected before and 3,12 months after therapy with LMV and ADV. Two groups of mutational sites were screened 12 montha after treatment. Results All 276 samples were classified as genotype B (50. 0%), genotype C (34. 8%), genotype D (3. 6%), genotype (B + C) (9. 4%), and undetermined type (2. 2%). There were significant differences of decline on levels of DNA of HBV, HBeAg and ALT after antiviral treatment between lamivudine and adefovir for 3 months (P<0. 05). However,the therapeutic effect of lamivudine was weaker than that of adefovir 12 months after therapy. Resistance site mutation occurred in 20 cases of LMV group,whereas no site mutation occurred in ADV group.Conclusion The major genotypes in Shenzhen area are genotype B and C,genotype B is a little dominant,and mixed genotypes of B and C accounts for a definite proportion.Although the short-term therapeutic effect of LMV is superior to ADV,the long-term antiviral efficacy of ADV is better in patients with chronic hepatitis B as a result of gradual appearance of resistance mutational genes.
