CAJ | 학술논문

目的分析拉米夫定治疗后慢性乙型肝炎酪氨酸(Y)、蛋氨酸(M)、天冬氨酸(D)、天冬氨酸(D)变异的相关因素.方法对169例经拉米夫定治疗12个月后的慢性乙型肝炎患者发生YMDD变异情况进行回顾性分析.采用荧光定量PCR和PCR产物测序等方法检测慢性乙型肝炎拉米夫定治疗前、治疗后HBV基因型、HBV DNA水平、HBeAg状态、ALT水平等指标.结果在169例患者中,基因型B共76例(44.97%),基因型C共93例(55.03%).拉米夫定治疗12个月后,46例(27.22%)患者发生YMDD变异,其中,基因型B变异27例(35.53%),基因型C变异19例(20.43%),两者有统计学差异(P<0.05).YMDD变异组患者治疗前HBV DNA水平显著高于YMDD未变异组[(7.26±0.58 vs6.44±0.65)log拷贝/ml,P<0.05].HBeAg阳性患者YMDD变异率显著高于HBeAg阴性患者(38.10%vs20.75%,P<0.05).YMDD变异组与未变异组在治疗前ALT水平上无明显差异[(136.09±28.21 vs 124.15±26.52)U/L,P>0.05].结论拉米夫定治疗慢性乙型肝炎发生YMDD变异与HBV基因型、HBV DNA水平、HBeAg状态等密切相关.拉米夫定治疗前,检测HBV基因型、HBV DNA水平,HBeAg状态等指标对慢性乙型肝炎抗病毒治疗具有重要意义.
목적분석랍미부정치료후만성을형간염락안산(Y)、단안산(M)、천동안산(D)、천동안산(D)변이적상관인소.방법대169례경랍미부정치료12개월후적만성을형간염환자발생YMDD변이정황진행회고성분석.채용형광정량PCR화PCR산물측서등방법검측만성을형간염랍미부정치료전、치료후HBV기인형、HBV DNA수평、HBeAg상태、ALT수평등지표.결과재169례환자중,기인형B공76례(44.97%),기인형C공93례(55.03%).랍미부정치료12개월후,46례(27.22%)환자발생YMDD변이,기중,기인형B변이27례(35.53%),기인형C변이19례(20.43%),량자유통계학차이(P<0.05).YMDD변이조환자치료전HBV DNA수평현저고우YMDD미변이조[(7.26±0.58 vs6.44±0.65)log고패/ml,P<0.05].HBeAg양성환자YMDD변이솔현저고우HBeAg음성환자(38.10%vs20.75%,P<0.05).YMDD변이조여미변이조재치료전ALT수평상무명현차이[(136.09±28.21 vs 124.15±26.52)U/L,P>0.05].결론랍미부정치료만성을형간염발생YMDD변이여HBV기인형、HBV DNA수평、HBeAg상태등밀절상관.랍미부정치료전,검측HBV기인형、HBV DNA수평,HBeAg상태등지표대만성을형간염항병독치료구유중요의의.
@@@@Objective To investigate the factors related to HBV YMDD mutations in chronic hepatitis B patients during lamivudine therapy. Methods One hundred and sixty-nine chronic hepatitis B patients receiving lamivudine therapy for more than one year were retrospectively enrol ed in the study. HBV genotypes, HBV DNA load, HBeAg status, and ALT levels were monitored prior to lamivudine treatment and at every three months during one year of lamivudine therapy. Results Of 169 pa-tients, 76 (44.97%) were infected with genotype B and 93 patients (55.03%) with genotype C. Total 46 patients (27.22%) with YMDD mutants were detected after one year of lamivudine therapy;there were significant differences in the rate of YMDD muta-tions between patients with genotypes B and C (35.53%vs 20.43%, P<0.05). The HBV DNA levels before treatment in patients with YMDD mutants were significantly higher than those in patients without YMDD mutants (7.26 ±0.58 vs 6.44 ±0.65 log copies/ml, P<0.05). Significant difference in the rate of YMDD mutations was observed between the patients with positive HBeAg and patients with negative HBeAg (38.10%vs 20.75%, P<0.05). No significant difference in the ALT levels were observed be-tween the patients with YMDD mutants and without YMDD mutants (136.09±28.21 vs 124.15±26.52 U/L, P>0.05). Conclusion HBV genotypes, HBV DNA levels, and HBeAg status are strongly correlated with the emergence of YMDD mutations in chronic hepatitis B patients during lamivudine therapy.