乙肝拉米夫定治疗前后YMDD变异与DNA载量的关系

目的探讨原发性肝癌患者拉米夫定治疗前后HBV YMDD变异与HBV DNA复制水平的相关性,为临床治疗提供依据。方法应用实时荧光聚合酶链反应（PCR）技术检测72例原发性肝癌患者未服用拉米夫定治疗前血清HBV DNA载量以及服用拉米夫定治疗12个月血清中YMDD突变情况。结果 72例原发性肝癌患者中,出现YMDD变异者35例（48.6%）,其中YIDD变异者28例,YVDD变异者4例,YIDD和YVDD混合变异者3例。治疗后YMDD突变组HBV DNA载量显著高于YMDD野生组,拉米夫定治疗后YIDD及YIDD＋YVDD杂合型的突变率明显增加,而对YVDD的突变率则有所降低。结论拉米夫定对原发性肝癌患者治疗前后HBV DNA复制水平无显著影响,而拉米夫定治疗后HBV DNA复制水平与YMDD突变具有相关性,可作为早期监测原发性肝癌HBV YMDD突变的观察指标之一。

Analysis on the relationship between YMDD mutation and the levels of HBV DNA in primary liver cancer patients before and after lamivudine treatment

Objective To investigate the relationship between YMDD mutation and HBV DNA replication level in primary liver cancer patients,to provide the basis for its diagnosis and treatment. Methods Using real-time fluorescence polymerase chain reaction（PCR）,the detection of HBV YMDD variation and the levels of HBV DNA was performed among 60 cases patients with primary liver cancer by treated with or with out lamivudine serum for 12 months. Results Among 72 patients with primary liver cancer patients,35 cases were YMDD mutation,including the YIDD variation in 28 cases,YVDD variation in 4 cases,YIDD and YVDD hybrid mutation in three cases. The detection rate of YMDD mutation was 48. 6%.The HBV DNA level in the YMDD mutation group was significantly higher than those in the YMDD wild group after lamivudine treatment. In addition,the mutation rate of YIDD and YIDD ＋ YVDD heterozygous type increased significantly after the lamivudine treatment,while the mutation rate of YVDD decreased. Conclusion Lamivudine treatment little affected the HBV DNA levels amongst patients with primary liver cancer. However,the level of HBV DNA was related with the YMDD mutation directly after the treatment of lamivudine,so can be used as early detection of HBV YMDD mutation amongst primary liver cancer patients.