CAJ | 학술논문

目的观察发生YMDD自然变异的慢性乙型肝炎(CHB)患者的临床特征,探讨HBVYMDD自然变异发生的可能机理,为CHB抗病毒治疗提供新思路.方法选择144例HBV DNA阳性、未经抗病毒治疗的CHB患者作为观察对象,采用PCR熔解曲线法检测其YMDD基因序列突变；同时对其进行HBV DNA定量、血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)和乙肝两对半等相关指标检测,并对患者性别、年龄及上述检测结果进行统计学分析.结果 144例未经抗病毒治疗的CHB患者中,有30例出现YMDD自然变异,变异检出率为20.8％,其中YIDD阳性19例(占63.3％),YVDD阳性8例(占26.7％),YIDD+YVDD同时阳性3例(占10％).YMDD自然变异组CHB患者年龄明显小于未变异组；HBV DNA定量值在105 copies/ml以上的CHB患者易发生YMDD自然变异,而HBV DNA定量低于105 copies/ml的CHB患者不易发生YMDD自然变异.CHB患者的性别、HBeAg和抗-HBe状态及肝功能损害程度与YMDD自然变异无关.结论 CHB患者中存在HBV YMDD自然变异,低龄和HBVDNA高值的患者易发生YMDD自然变异；自然变异与患者性别、HBeAg和抗-HBe状态及肝功能损害程度无关.
목적 관찰발생YMDD자연변이적만성을형간염(CHB)환자적림상특정,탐토HBVYMDD자연변이발생적가능궤리,위CHB항병독치료제공신사로.방법 선택144례HBV DNA양성、미경항병독치료적CHB환자작위관찰대상,채용PCR용해곡선법검측기YMDD기인서렬돌변；동시대기진행HBV DNA정량、혈청병안산안기전이매(ALT)、천문동안산안기전이매(AST)화을간량대반등상관지표검측,병대환자성별、년령급상술검측결과진행통계학분석.결과 144례미경항병독치료적CHB환자중,유30례출현YMDD자연변이,변이검출솔위20.8％,기중YIDD양성19례(점63.3％),YVDD양성8례(점26.7％),YIDD+YVDD동시양성3례(점10％).YMDD자연변이조CHB환자년령명현소우미변이조；HBV DNA정량치재105 copies/ml이상적CHB환자역발생YMDD자연변이,이HBV DNA정량저우105 copies/ml적CHB환자불역발생YMDD자연변이.CHB환자적성별、HBeAg화항-HBe상태급간공능손해정도여YMDD자연변이무관.결론 CHB환자중존재HBV YMDD자연변이,저령화HBVDNA고치적환자역발생YMDD자연변이；자연변이여환자성별、HBeAg화항-HBe상태급간공능손해정도무관.
Objective To investigate the possible mechanism of spontaneous HBV YMDD mutation observing the clinical characteristics of chronic hepatitis B (CHB)and provide new ideas for antiviral therapy of CHB.Methods 144 HBV DNA positive CHB cases no antiviral therapy were observed.HBV YMDD mutations were detected by PCR melting curve method and some experimental indexes,for example,HBV DNA quantitative analysis,serum alanine aminotransferase (ALT),aspartate aminotransferase (AST),and antigens/antibodies of HBV (including HBsAg,HBsAb,HBeAg,HBeAb and HBcAb),were also determined.Statistical analysis of these experimental data and information of these cases such as age and gender were performed.Results 30 cases with spontaneous HBV YMDD mutation,of which 19 (63.3％) was YIDD positive,8(26.7％) YVDD positive,and 3(10.0％) YIDD and YVDD positive,were found out among 144 subjects.Age of the group with spontaneous HBV YMDD mutation was significantly lower than that of those with non-mutation.The frequency of spontaneous HBV YMDD mutation was obviously high when HBV DNA are above 105 copies/ml in body.However,occurrence of spontaneous HBV YMDD mutation had nothing to do with gender,HBeAg,HBeAb or liver function damage.Conclusions There are spontaneous HBV YMDD mutation in patients with CHB,especially younger patients and patients high HBV DNA copies.And occurrence of spontaneous HBV YMDD mutation doesn' t correlate with gender,HBeAg,HBeAb or liver function damage.