【摘要】 目的探讨慢性乙型肝炎患者中拉米夫定诱导的 YMDD 变异和前 C 区1896位核苷酸以及 C区启动子1762和1764位核苷酸变异的检出率及其临床意义。方法采用基因芯片技术检测拉米夫定治疗6个月以上的122例慢性乙型肝炎患者血清中前 C 区1896位以及 C 区启动子1762和1764位核苷酸变异发生率。结果 122俐慢性乙型肝炎患者中检出40例 YMDD 变异阳性患者,检出率为32.8%。发生 YMDD变异后,HBV DNA 反跳,ALT 和 AST 增高,差异有统计学意义(P<0.01)。YMDD 变异阳性患者前 C 区1896位和 C 区启动子1762和1764位核苷酸变异检出率显著高于无 YMDD 变异的慢性乙型肝炎患者,差异有统计学意义(P<0.01)。YMDD 变异阳性伴前 C 区1896位以及 C 区启动子1762和1764位核苷酸变异患者与无前 C 区1896位以及 C 区启动于1762和1764位核苷酸变异的 YMDD 变异阳性患者比较,病情容易加重.易发展为重型肝炎或肝硬化,但差异无统计学意义(P>0.05)。结论拉米夫定诱导的 YMDD 变异患者容易发生前 C 区1896位/C 区启动子1762和1764位核菅酸变异,但与病情加重和预后无相关性。更多还原

【Abstract】 Objective To mvesugate the Tate of YMDD mutation accompamed with pre-core(region and core promotor region mutation and the clinical significance.Methods YMDD mutation and pre-core(at 1896 nu- cleotide)region and core promotor region(at 1762.1764 nucleotide)mutation were detected from the 122 patients with chronic hepatitis B virus after receiving lamivudine treatment above 6 months.Results 40 cases were tested for YMDI)mutations in 122 HBV patients with lamivudine treatment,and the positive rate of YMDD mutation was 32.8 %.After YMDD mutation,ALT,AST and HBV DNA of the patients significantly increased(P<0.01).The patients with YMDD mutation had higher rate of pre-core region(at 1896 nucleotide)and core promotor region(at 1762,1764 nucleotide)mutation than those without YMDD mutation,and the difference was significant in statis- tics.The patients with YMDD mutation accompanied with pre-core region(at 1896 nucleotide)and core promotor region(at 1762,1764 nucleotide)mutation tend to aggravate the ill condition,more easily developed into severe hep- atitis or liver cirrhosis,but there was no significant difference in statistics(P>0.05).Conclusion The patients with YMDD mutation had higher rate of pre-core region(at 1896 nucleotide)and basal core promotor region(at 1762, 1764 nucleotide)mutation than those without YMDD mutation,but there was no correlation between the mutation and the deterioration of disease condition and the bad prognosis.更多还原