【摘要】 目的探讨拉米夫定(LAM)单独及与恩替卡韦(ECV)联合治疗慢性乙型肝炎(CHB)对不同基因型HBV耐药突变的影响。方法选择CHB患者100例,其中B基因型30例,C基因型70例。将患者随机分为联合用药组及单独用药组各50例,联合用药组每日口服LAM 50 mg和ECV 0.5 mg,单独用药组每日单用LAM 100 mg。治疗后24个月采用PCR-反向点杂交芯片法检测血清HBV基因型耐药突变情况及耐药基因变异类型。结果联合用药组检出耐药突变4例,检出率为8%,其变异类型分别为rt T184L+L180M+M204 V、rt T184 L+S202 G+L180 M+M204 I、rt M250 L+M204 I,其中C基因型3例(突变率为9.1%),B基因型1例(突变率为5.9%);单独用药组检出耐药突变25例,检出率为50%,其变异类型分别为rt L180M+M204 V、rt L180 M+M204 I、rt M204 I,其中C基因型18例(突变率为48.6%),B基因型7例(突变率为53.8%)。两组耐药突变检出率比较,P<0.05,两组B型和C型基因的耐药突变率比较均无显著性差异。结论 LAM单用治疗CHB的耐药突变检出率明显高于与ECV联合治疗者,LAM单用及与ECV联合治疗对CHB不同基因型HBV耐药突变无明显影响。更多还原

【Abstract】 Objective To observe the drug-resistant gene mutations of different HBV genotypes of patients with chronic hepatitis B( CHB) after treatment of lamivudine( LAM) or the combined treatment of entecavir( ECV) and LAM.Methods One hundred CHB patients with 30 cases of genotype B and 70 cases of genotype C were randomly divided into two groups: the combination group and the single-drug group,50 patients in each group. The combination group was treated with 50 mg LAM and 0. 5 mg ECV everyday orally. The single-drug group was treated with 100 mg LAM orally. After a 24-month-treatment,we detected HBV genotype and gene mutations by PCR-RD blot. Results In the combination group,4cases( 8%) of resistance gene mutations were detected with the types of rt T184 L + L180 M + M204 V,rt T184 L + S202 G +L180M + M204 I and rt M250 L + M204 I,and there were 3 cases( mutation rate 9. 1%) of genotype C and 1 case( 5. 9%)of genotype B. In the single-drug group,25 cases( 50%) of resistance gene mutations were detected with the types of rt L180 M + M204 V,rt L180 M + M204 I and rt M204 I,and there were 18 cases( 48. 6%) of genotype C and 7 cases( 53. 8%) of genotype B. Significant different was found in the rate of drug-resistant mutation between the two groups( P <0. 05). There was no significant difference in the rate of drug resistance mutation of genotypes B and C between the two groups. Conclusions The detection rate of drug-resistant mutation was significantly lower in treatment with LAM combined with ECV than that in treatment with LAM. The treatment with only LAM or LAM combined with ECV had no effect on drug-resistant gene mutations of different HBV genotypes in pationts with CHB.更多还原