【摘要】 目的探讨乙型肝炎病毒(HBV)基因型与核苷(酸)类似物耐药变异的关系。方法湖南省衡阳地区122例慢性乙型肝炎患者接受拉米夫定治疗(100mg/d)48～96周,发生耐药变异者改用阿德福韦酯治疗(10mg/d)96周。采用直接测序法进行HBV基因分型,同时检测拉米夫定、阿德福韦酯和恩替卡韦耐药变异位点。结果122例慢性乙型肝炎患者中,B基因型86例(70.49%),C基因型24例(19.67%),未分型12例(9.84%)。42例检出拉米夫定变异株,其中B基因型32例,C基因型10例,B、C基因型拉米夫定耐药变异率分别为37.21%(32/86)和41.67%(10/24),差异无显著性(χ2=0.16,P=0.69);42例经阿德福韦酯治疗48周和96周的变异发生率分别为0.00%(0/42)和2.38%(1/42),B、C基因型阿德福韦酯耐药变异率分别为3.13%(1/32)和0.00%(0/10)。拉米夫定耐药变异类型主要为rtM204V+rtL180M(35.71%)和rtM204I(38.10%);B、C基因型比较,拉米夫定耐药变异类型差异无显著性(χ2=17.44,P=0.23)。结论湖南省衡阳地区HBV基因型以B型为主,C型次之;HBV基因型对拉米夫定耐药变异发生率及变异类型无明显影响。更多还原

【Abstract】 ObjectiveTo study the relationship between HBV genotypes and nucleolide analogues drug-resistance mutations. MethodsOne hundred and twenty-two patients with chronic hepatitis B were treated with lamivudine 100mg/d for 48~96 weeks,patients who developed lamivudine-resistance mutations used adefovir dipivoxil 10mg/d for 96 weeks instead of lamivudine. HBV genotypes,lamivudine,adefovir dipivoxil and entecavir resistance mutations were determined by DNA sequencing. ResultsAmong 122 cases,86 (70.49%) were genotype B,24 (19.67%) were genotype C,and 12(9.84%) were not classified. 42 lamivudine-resistance mutants (32 mutants of genotype B,and 10 mutants of genotype C) were found in 122 cases. The incidence of mutations was 37.21%(32/86) and 41.67%(10/24) in HBV genotypes B and C,respectively,there was no significant difference between the two (χ2=0.16,P=0.69). The incidence of mutations was 0.00%(0/42) and 2.38%(1/42) in 42 patients treated with adefovir dipivoxil for 48 and 96 weeks,respectively,the incidence of adefovir dipivoxil mutations was 3.13%(1/32) and 0.00%(0/10) in genotypes B and C,respectively. The main types of lamivudine-resistance mutations were rtM204V+rtL180M(35.71%) and rtM204I(38.10%); Lamivudine-resistance mutation types showed no significant difference between HBV genotypes B and C(χ2=17.44,P=0.23). ConclusionHBV genotype B is the most prevalent,and genotype C is the second in Hengyang of Hunan. HBV genotypes have no obvious influence on the incidences and types of mutation during lamivudine therapy.更多还原