摘要
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SPSS17．0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IAM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。
Objective To analyze the types of mutation in the RT region of HBV polymerase in patients after the treatment of nueleoside/nueleotide 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 mtdti-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 ＋ LI80M ＋ 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.
出处
《国际流行病学传染病学杂志》
CAS
2012年第6期386-389,共4页
International Journal of Epidemiology and Infectious Disease
