CAJ | 학술논문

目的探讨核苷(酸)类药物(NA)治疗慢性乙型肝炎后HBV聚合酶逆转录区(RT区)基因变异类型及其特点.方法对2007年2月至2011年11月送检的142份慢性乙型肝炎患者的血清样本进行HBV聚合酶RT区基因序列检测,并采用SPSS 17.0软件分析统计学意义.结果在142份血清样本中,87份(61.3％)发现9个已知耐药位点变异,有21种变异模式；43份(49.4％)表现为多位点变异,其中9份(10.3％)为多重耐药变异.单用拉米夫定(LAM)的样本中检出2份A181T变异,1份M204V+ L180M+A194T变异(替诺福韦相关变异)；在单用阿德福韦酯(ADV)的样本中检出2份M204I变异.这些变异比较少见,推测LAM和ADV可能存在部分交叉耐药情况.结论随着临床实践的不断深入,HBV聚合酶RT区的变异模式将会更加复杂,包括多位点变异和多重耐药变异等,临床医师应高度重视并认真应对.
목적 탐토핵감(산)류약물(NA)치료만성을형간염후HBV취합매역전록구(RT구)기인변이류형급기특점.방법 대2007년2월지2011년11월송검적142빈만성을형간염환자적혈청양본진행HBV취합매RT구기인서렬검측,병채용SPSS 17.0연건분석통계학의의.결과 재142빈혈청양본중,87빈(61.3％)발현9개이지내약위점변이,유21충변이모식；43빈(49.4％)표현위다위점변이,기중9빈(10.3％)위다중내약변이.단용랍미부정(LAM)적양본중검출2빈A181T변이,1빈M204V+ L180M+A194T변이(체낙복위상관변이)；재단용아덕복위지(ADV)적양본중검출2빈M204I변이.저사변이비교소견,추측LAM화ADV가능존재부분교차내약정황.결론 수착림상실천적불단심입,HBV취합매RT구적변이모식장회경가복잡,포괄다위점변이화다중내약변이등,림상의사응고도중시병인진응대.
Objective To analyze the types of mutation in the RT region of HBV polymerase in patients after the treatment of nucleoside/nucleotide analogs.Methods The RT regions of HBV from 142 serum samples of hepatitis B patients received from February 2007 to November 2011 were sequenced,and the statistical significances were analyzed by SPSS 17.0 software.Results There were 9 known resistance site mutations found in 87 samples (61.3 ％) among 142 samples,including 21 mutation patterns.Forty-three samples (49.4％) showed multi-site mutation,in which 9 samples (10.3％) were multidrug resistant mutation.In the patients treated with lamivudine (LAM) alone,there were 2 samples of A181T mutation and 1 sample of M204V + L180M + A194T mutation (tenofovir-related mutation).M204I mutation was found in 2 patients treated with adefovir dipivoxil (ADV) alone.These mutations were relatively rare.It suggested that LAM and ADV cross-resistance might exist in some circumstances.Conclusions By the further research of clinical practice,the patterns of mutation in the RT region of HBV polymerase will be more complex including multi-site mutation and multidrug resistant mutation.The clinician should pay great attention.