乙型肝炎病毒多聚酶基因YMDD变异与临床治疗反应

目的：了解深圳地区慢性乙型肝炎患者在长期拉米夫定治疗中HBV多聚酶基因YMDD变异的情况及其对治疗反应的影响。方法：对100例拉米夫定治疗中28例出现血清病毒核酸（HBV DNA）阳性的患者,采用限制性片段长度多态性分析法（PCR－RFLP）检测YMDD变异,并观察其血清HBV DNA及丙氨酸转氨酶（ALT）水平。结果：100例中有17例YMDD变异阳性，其中以YVDD（M550V）变异为主,占64．7％（11／17），YIDD（M550I）变异为35．3％（6／17）。发生YMDD变异的患者均伴有HBV DNA及ALT水平反跳，1例住院患者停用拉米夫定后出现病情加重。结论：深圳地区慢性乙型肝炎患者在长期拉米夫定治疗中（疗程1年，100md/d）HBV多聚酶基因YMDD变异率为17．0％（17／100）。发生变异者较无变异者疗效降低，检测YMDD变异有助于监测疗效。

Association between hepatitis B virus polymerase gene mutation and clinical response

Objective To study the relationship between YMDD mutation of hepatitis B virus polymerase gene and clinical response. Methods 28 samples of serum with positive HBV-DNA among 100 chronic hepatitis patients were analyzed by restriction fragment length polymorphism of the PCR products(PCR-RFLP). Serum HBV DNA and alanine aminotransferase (ALT) levels were also examined. Results YMDD mutation was positive in 17 of 100 serum samples. 11 of 17 were YVDD mutation(M550V) and 6 were YIDD mutation (M550I). Patients with YMDD mutation were associated with increased ALT and HBV DNA. Conclusion Detection of mutations in the YMDD motif of HBV polymerase gene during lamivudine therapy is helpful for monitoring therapeutic outcomes.