中华检验医学杂志
中華檢驗醫學雜誌
중화검험의학잡지
CHINESE JOURNAL OF LABORATORY MEDICINE
2013年
1期
53-58
,共6页
获得性免疫缺陷综合征%治疗失败%HIV-1%抗药性,病毒
穫得性免疫缺陷綜閤徵%治療失敗%HIV-1%抗藥性,病毒
획득성면역결함종합정%치료실패%HIV-1%항약성,병독
Acquired immunodeficiency syndrome%Treatment failure%HIV-1%Drug resistance,viral
目的 探讨云南地区抗病毒治疗失败的艾滋病患者中HIV-1基因耐药突变位点间的差异.方法 2009年8月至2011年1月,选择151例云南省HIV/AIDS抗病毒治疗失败患者作为监测对象,进行横断面调查.用RT-PCR方法扩增HIV-1 pol区基因,所得扩增片段进行测序后提交斯坦福大学HIV耐药数据库分析耐药突变发生情况.对所得到的HIV-1耐药基因突变频率和位点与HIV/AIDS患者的性别、民族、感染途径和亚型进行统计学处理分析,采用x2检验或Fisher精确概率法进行统计学检验.结果 151例患者中有123例患者的样本扩增成功,共获得123例患者蛋白酶区和逆转录酶区的基因扩增片段.RT区主要耐药位点是M184(72.4％,89/123),其次是K103(47.2％,58/123),其余依次为G190(34.1％,42/123)、Y181 (29.3％,36/123)、T215(26.0％,32/123)、K101(17.1％,21/123)、D67 (15.4％,19/123).突变位点V75、A62、M230在女性中比男性发生率高(x2=7.001,6.975,5.446,P均＜0.05)；在汉族人群中,变异位点T215、K70、T69比其他少数民族发生率高(x2 =5.290,4.060,3.860,P均＜0.05)；位点M41在少数民族中并未出现；在性接触感染途径人群中针对NRTI的突变位点T215、T69比在静脉吸毒人群中发生率高(x2=10.431,7.952,P均＜0.05),V75在静脉吸毒人群中并未出现；在针对NNRTI的耐药位点中,G190在静脉吸毒人群比性接触感染途径人群间发生率高(x2=6.669,P＜0.05),M230在静脉吸毒人群中并未出现；不同亚型中突变位点V75、T69、M230在CRF01_AE亚型人群中比在B亚型中发生率高,而L74在CRF01_AE亚型中并未出现.结论 HIV基因耐药突变是导致云南德宏、个旧、文山、玉溪等地区AIDS患者抗病毒治疗失败的主要原因.结果分析显示这些耐药突变位点的发生在民族、性别、传播途径及亚型不同的患者中存在着显著差异.
目的 探討雲南地區抗病毒治療失敗的艾滋病患者中HIV-1基因耐藥突變位點間的差異.方法 2009年8月至2011年1月,選擇151例雲南省HIV/AIDS抗病毒治療失敗患者作為鑑測對象,進行橫斷麵調查.用RT-PCR方法擴增HIV-1 pol區基因,所得擴增片段進行測序後提交斯坦福大學HIV耐藥數據庫分析耐藥突變髮生情況.對所得到的HIV-1耐藥基因突變頻率和位點與HIV/AIDS患者的性彆、民族、感染途徑和亞型進行統計學處理分析,採用x2檢驗或Fisher精確概率法進行統計學檢驗.結果 151例患者中有123例患者的樣本擴增成功,共穫得123例患者蛋白酶區和逆轉錄酶區的基因擴增片段.RT區主要耐藥位點是M184(72.4％,89/123),其次是K103(47.2％,58/123),其餘依次為G190(34.1％,42/123)、Y181 (29.3％,36/123)、T215(26.0％,32/123)、K101(17.1％,21/123)、D67 (15.4％,19/123).突變位點V75、A62、M230在女性中比男性髮生率高(x2=7.001,6.975,5.446,P均＜0.05)；在漢族人群中,變異位點T215、K70、T69比其他少數民族髮生率高(x2 =5.290,4.060,3.860,P均＜0.05)；位點M41在少數民族中併未齣現；在性接觸感染途徑人群中針對NRTI的突變位點T215、T69比在靜脈吸毒人群中髮生率高(x2=10.431,7.952,P均＜0.05),V75在靜脈吸毒人群中併未齣現；在針對NNRTI的耐藥位點中,G190在靜脈吸毒人群比性接觸感染途徑人群間髮生率高(x2=6.669,P＜0.05),M230在靜脈吸毒人群中併未齣現；不同亞型中突變位點V75、T69、M230在CRF01_AE亞型人群中比在B亞型中髮生率高,而L74在CRF01_AE亞型中併未齣現.結論 HIV基因耐藥突變是導緻雲南德宏、箇舊、文山、玉溪等地區AIDS患者抗病毒治療失敗的主要原因.結果分析顯示這些耐藥突變位點的髮生在民族、性彆、傳播途徑及亞型不同的患者中存在著顯著差異.
목적 탐토운남지구항병독치료실패적애자병환자중HIV-1기인내약돌변위점간적차이.방법 2009년8월지2011년1월,선택151례운남성HIV/AIDS항병독치료실패환자작위감측대상,진행횡단면조사.용RT-PCR방법확증HIV-1 pol구기인,소득확증편단진행측서후제교사탄복대학HIV내약수거고분석내약돌변발생정황.대소득도적HIV-1내약기인돌변빈솔화위점여HIV/AIDS환자적성별、민족、감염도경화아형진행통계학처리분석,채용x2검험혹Fisher정학개솔법진행통계학검험.결과 151례환자중유123례환자적양본확증성공,공획득123례환자단백매구화역전록매구적기인확증편단.RT구주요내약위점시M184(72.4％,89/123),기차시K103(47.2％,58/123),기여의차위G190(34.1％,42/123)、Y181 (29.3％,36/123)、T215(26.0％,32/123)、K101(17.1％,21/123)、D67 (15.4％,19/123).돌변위점V75、A62、M230재녀성중비남성발생솔고(x2=7.001,6.975,5.446,P균＜0.05)；재한족인군중,변이위점T215、K70、T69비기타소수민족발생솔고(x2 =5.290,4.060,3.860,P균＜0.05)；위점M41재소수민족중병미출현；재성접촉감염도경인군중침대NRTI적돌변위점T215、T69비재정맥흡독인군중발생솔고(x2=10.431,7.952,P균＜0.05),V75재정맥흡독인군중병미출현；재침대NNRTI적내약위점중,G190재정맥흡독인군비성접촉감염도경인군간발생솔고(x2=6.669,P＜0.05),M230재정맥흡독인군중병미출현；불동아형중돌변위점V75、T69、M230재CRF01_AE아형인군중비재B아형중발생솔고,이L74재CRF01_AE아형중병미출현.결론 HIV기인내약돌변시도치운남덕굉、개구、문산、옥계등지구AIDS환자항병독치료실패적주요원인.결과분석현시저사내약돌변위점적발생재민족、성별、전파도경급아형불동적환자중존재착현저차이.
Objective To analyze the prevalence and diversity of genotype resistant mutations in 123 HIV/AIDS patients experiencing failure of high antiretroviral therapy (HAART) in Yunnan province.Methods A cross-sectional survey was conducted among 151 HIV/AIDS patients experiencing failure of antiretroviral therapy form January 2011 to January 2012 in Yunnan province.The HIV-1 pol gene was amplified by reverse transcription-polymerase chain reaction (RT-PCR),the sequences were then submitted to the Stanford University HIV drug resistance database to analyze the prevalence of resistant mutations.The resistant mutations were statistically analyzed by gender,ethnic groups,transmission route and subtype,respectively.The chi-square or fisher's exact test was used for statistical test.Results Of the 151 cases,123 plasma samples were amplified successfully for protease PR (codon 1-99) and reverse transcriptase RT (codon 1-272) fragments.The most common mutation was M184 (72.4％),followed by the mutation at position K103 (47.2％),T215 (26.0％),D67 (15.4％),G190 (34.1％),Y181 (29.3％),K101 (17.1％).The frequency of mutations at position V75,A62 and M230 was higher in male population than that in female population (x2 =7.001,6.975,5.446,P ＜ 0.05).The frequency of variants at position Tl215,K70 and T69 was higher in the Han population than in the other ethnic population(x2 =5.290,4.060,3.860,P＜ 0.05).It was interesting that the variant M41L was rare in the other ethnic groups.The significant difference existed at various transmission routes.Frequencies of variants at position T215 and T69 were significantly higher among people infected HIV-I through sexual contact than the intravenous drug users (x2 =10.431,7.952,P ＜ 0.05).Frequencies of variants at position G190 were significantly higher among the intravenous drug users than the population infected HIV-1 through sexual contact(x2 =6.669,P ＜ 0.05),but the variant M230L never occurred in intravenous drug users.The RT mutations V75,T69,M230 were more frequently occurred in patients infected with CRF01_AE than in patients with subtype B (P＜ 0.05).The mutation L74 was never seen in patients infected with CRFOI_AE (P ＜ 0.05).Conclusions The HIV/AIDS patients with failure of high antiretroviral therapy (HAART) were attributed to HIV-1 genotype resistance mutations.The mutation sites among the HAART failure patients from the regions of Dehong,Gejiu,Wenshan and Yuxi were significant difference accordance among the gender,ethnicith,transmission route and subtype,respectively.
