CAJ | 학술논문

目的了解河南省一线抗病毒治疗失败的艾滋病患者基因型耐药的状况,并对不同地区患者的耐药情况进行比较.方法选取2010年河南省3个地区(A、B和C)一线抗病毒治疗失败的艾滋病患者276例,进行CD4+T淋巴细胞、病毒载量和基因型耐药检测,对耐药的发生率和耐药突变位点进行分析.结果总耐药率为68.48％( 176/257,有19例未成功扩增),非核苷类反转录酶抑制剂(NNRTIs)的耐药率最高为67.70％,核苷类反转录酶抑制剂(NRTIs)的耐药率为54.09％,蛋白酶抑制剂(PIs)的耐药率为1.18％.A、B和C地区的耐药率分别为82.35％、97.47％和52.80％,3个地区患者的耐药率差异有统计学意义(x2=50.624,P=0.000)；NNRTIs和NRTIs的耐药率差异也有统计学意义(x2=48.771,P=0.000;x2=33.912,P=0.000).M184V/I是发生最多的NRTIs类耐药突变位点,发生率为26.46％,A和B地区的M184V/I发生率(47.06％和49.37％)显著高于C地区(13.04％)(x2=39.905,P=0.000),其次是TAMs相关突变,TAMs-1和TAMs-2分别为8.56％和4.28％,C地区的TAMs-1显著少于A和B地区(x2=13.499,P=0.001).≥1 TAM的为40.47％,其中T215Y/F最多,发生率为33.85％.K103N是出现最多的NNRTIs类耐药突变,为31.13％,其在3个地区发生率的差异均有统计学意义(x2=14.213,P=0.001).耐PIs的突变位点有2个,M461/L为1.17％,V82F为0.39％,A地区未出现主要耐PIs的突变位点.结论河南省不同地区的耐药状况有明显差异,应区别对待,而艾滋病二线抗病毒治疗工作应及时、严格和规范.
목적 료해하남성일선항병독치료실패적애자병환자기인형내약적상황,병대불동지구환자적내약정황진행비교.방법 선취2010년하남성3개지구(A、B화C)일선항병독치료실패적애자병환자276례,진행CD4+T림파세포、병독재량화기인형내약검측,대내약적발생솔화내약돌변위점진행분석.결과 총내약솔위68.48％( 176/257,유19례미성공확증),비핵감류반전록매억제제(NNRTIs)적내약솔최고위67.70％,핵감류반전록매억제제(NRTIs)적내약솔위54.09％,단백매억제제(PIs)적내약솔위1.18％.A、B화C지구적내약솔분별위82.35％、97.47％화52.80％,3개지구환자적내약솔차이유통계학의의(x2=50.624,P=0.000)；NNRTIs화NRTIs적내약솔차이야유통계학의의(x2=48.771,P=0.000;x2=33.912,P=0.000).M184V/I시발생최다적NRTIs류내약돌변위점,발생솔위26.46％,A화B지구적M184V/I발생솔(47.06％화49.37％)현저고우C지구(13.04％)(x2=39.905,P=0.000),기차시TAMs상관돌변,TAMs-1화TAMs-2분별위8.56％화4.28％,C지구적TAMs-1현저소우A화B지구(x2=13.499,P=0.001).≥1 TAM적위40.47％,기중T215Y/F최다,발생솔위33.85％.K103N시출현최다적NNRTIs류내약돌변,위31.13％,기재3개지구발생솔적차이균유통계학의의(x2=14.213,P=0.001).내PIs적돌변위점유2개,M461/L위1.17％,V82F위0.39％,A지구미출현주요내PIs적돌변위점.결론 하남성불동지구적내약상황유명현차이,응구별대대,이애자병이선항병독치료공작응급시、엄격화규범.
Objective To understand the current situation related to genotypic resistance in patients receiving the first-line antiretroviral treatment,but with with virologic failure,in Henan province and to compare the patterns of drug resistance in patients from different areas.Methods 276 patients with virologic failure on first-line antiretroviral treatment were selected in three different areas of Henan,in 2010.CD4 +T cells,virus load and genotypic resistance were measured and tested.Prevalence and mutations related to drug-resistant were analyzed.Results The overall prevalence of drug-resistance was 68.48％ in 257 patients,with non-nucleoside reverse transcriptase inhibitor (NNRTIs) as 67.70％.Rate of nucleoside reverse transcriptase inhibitor (NRTIs) was 54.09％,and protease inhibitors (PIs) was 1.18％.The prevalence rates of drug-resistance in A,B and C groups were 82.35％,97.47％ and 52.80％,respectively,and withs significant differences (x2=50.624,P=0.000).The Prevalence rates related to resistance of NNRTIs and NRTIs were also significantly different ( x2＝48.771,P=0.000 and x2=33.912,P=0.000).26.46％ of the samples had M184V/I mutation which was the highest NRTIs mutation among the 257 patients.The prevalence rates on resistance of A and B were 47.06％ and 49.37％,higher than that of C( 13.04％,x2=39.905,P=0.000)followed by TAMs,TAMs-1 and TAMs-2 which were 8.56％ and 4.28％.C had the lower prevalence of TAMs-1 thanA and B (x2=13.499,P=0.001).40.47％ of the samples harbored ≥1 TAM,with T215Y/F having the most,as 33.85％.31.13％ of 257 patients appeared most NNRTIs mutation K103N in this study,with the prevalence rates also significant different (x2=14.213,P=0.001 ) in the three areas.Two PIs mutations were detected in 257 patients:M461/L,(1.17％) and V82F (0.39％).However,none was detected in area A.Conclusion Different patterns of drug resistance were found in different areas of Henan province and should be treated differently.The work related to AIDS second-line antiretroviral therapy in Henan should be more opportune,rigorous and standardized.