基因芯片监测拉米夫定致乙型肝炎病毒耐药突变的临床研究

目的 研究基因芯片技术在监测拉米夫定致乙型肝炎病毒(HBV)耐药突变中的临床意义。方法应用前瞻性方法,对20例经拉米夫定治疗和10例未治疗的乙型肝炎患者观察18个月,以聚合酶链反应扩增血清HBV,应用已研发的4位点拉米夫定耐药检测芯片监测YMDD相关突变。结果 基因芯片技术监测能有效分辨野生型和突变型HBV。HBV的耐药突变随用药时间延长,突变率显著增加(x~2=6.6 9,P<0.01),突变类型以M539V L515M为主,次之为M539I。HBV在YMDD突变后,继续应用拉米夫定对突变型病毒无效。结论 在应用拉米夫定时需要定期检测YMDD突变,常规的HBV DNA定性技术与基因芯片相比,可能会出现结论偏差,后者是最好的方法之一。出现耐药突变后,继续使用拉米夫定对耐药株无效,应停用或更换其它治疗方案。

Clinical study of oligonucleotide microarray on monitoring the lamivudine-resistance mutations in hepatitis B virus

Objective To evaluate the mutations of lamivudine-resistance using oligonucleotide microarray in hepatitis B virus (HBV) infected patients. Methods A randomized clinical trial was conducted on 20 lamivudine-treated patients for 18 months and 10 patients as controls. The serum HBV DNA was amplified by PCR and the lamivudine-resistance mutations in YMDD region were assayed-by 4 sites microarray developed before. Results This microarray could clearly differentiate the wide-type from mutated-type HBV with lamivudine-resistance mutations. The rate of mutations in YMDD region increased with the time of lamivudine treatment (x2= 6.69, P < 0.01). The most common mutated type was M539V L515M and next M539I. Continuous administration of lamivudine was no benefit for inhibiting the replication of HBV with YMDD mutation but helpful for wide-type HBV. Conclusions The routine serum HBV DNA assay by PCR may introduce prejudice in monitoring HBV inhibitory effect by lamivudine, while the microarray technique can avoid this and is one of the best ways to monitor the lamivudine-resistance mutations in HBV. There is no effect of lamivudine on HBV with YMDD mutation in clinical practice.