摘要
目的:分析乙型肝炎病毒(HBV)逆转录酶区A181位点(reverse transcriptase A181,rtA181)变异的临床特征,为抗病毒治疗提供理论基础。方法:通过PCR产物测序法确定HBV耐药位点和基因型,收集85例经核苷(酸)类似物治疗产生rtA181变异的患者标本,对其临床资料进行回顾,并对发生耐药时的丙氨酸氨基转移酶(ALT)、HBsAg、HBeAg、HBV DNA等指标进行检测。结果:rtA181变异至少有8种不同模式,主要分布在阿德福韦单药和拉米夫定换用(或加用)阿德福韦治疗组中。其中B基因型患者13例(15.7%),C基因型患者72例(84.3%),基因型在rtA181变异模式中无统计学差异(P=0.175)。发生rtA181变异时,患者ALT、HBV DNA、HBsAg等指标仍有明显改善(P值分别为<0.001、0.013和<0.001),且HBsAg水平在rtA181T变异组和rtA181V变异组之间存在差异[(3.40±0.35)lgCOI vs(3.62±0.54)lgCOI,P=0.030]。结论:rtA181变异主要和临床使用阿德福韦有关,变异模式在B、C基因型无明显差别。rtA181变异后部分患者仍有生化和病毒学指标的改善,rtA181T变异后的HBsAg水平较rtA181V的低。
Objective：To analyze the characteristics of the HBV rtA181 mutation,and to provide the theoretical basis for anti-viral treatment. Methods：Eighty-five patients’ serum samples of rtA181 mutation were collected,and the liver function,surface antigen,e antigen and HBV DNA at the occurrence of resistance were amalyzed. PCR products were sequenced to determine the resistance mutations and genotypes. Results：Eight different resistance patterns were observed in rtA181 mutations, which were mainly in adefovir（ADV） monotherapy and ADV plus or change LAM groups. There were 13（15.7%） patients with HBV genotype B and 72（84.3%） with genotype C. The genotypes showed no significant difference in rtA181 mutation patterns （P = 0.175）. After occurrence rtA181 mutation,ALT,HBV DNA and HBsAg were still significant improved （P value were 〈 0.001,0.013 and 〈 0.001,respectively）,and the HBsAg level was different between rtA181T and rtA181V group [（3.40 ± 0.35）lgCOI vs（3.62 ± 0.54）lgCOI,P = 0.030]. Conclusion：The rtA181 mutation was relevant to adefovir medication,and has no significant difference in HBV genotype B and C. Some patients still received biochemical and virological response after rtA181 mutation. HBsAg level of rtA181T mutation group was lower than that of rtA181V group.
出处
《南京医科大学学报（自然科学版）》
CAS
CSCD
北大核心
2013年第9期1265-1269,共5页
Journal of Nanjing Medical University(Natural Sciences)
基金
军队基金课题(012046)
