不同基因型乙型肝炎病毒患者拉米夫定治疗期间YMDD突变株的变化分析

目的研究不同基因型乙型肝炎病毒（HBV）患者拉米夫定治疗期间酪氨酸-蛋氨酸-天冬氨酸-天冬氨酸（YMDD）突变株的变化。方法采用实时荧光聚合酶链反应（PCR）技术和基因测序法分别对115例接受拉米夫定治疗的乙型肝炎患者血清进行乙型肝炎病毒基因（HBV DNA）水平、YMDD突变株及基因型检测。结果拉米夫定治疗时间〈12个月、12~24个月及〉24个月患者的HBV DNA阳性率分别为75%、35%、16%,YMDD变异率分别为22%、54%、100%。对115例乙型肝炎患者进行HBV基因分型发现,B型占17%,C型占75%,B、C混合型占8%;其中,B型、C型患者中YMDD变异率分别为21%、19.5%,B、C混合型患者中未发现YMDD变异。HBV DNA与HBV的YMDD变异率无明显相关性（P〉0.05）。结论拉米夫定治疗期间,HBV的YMDD变异不受病毒基因型的影响。

Study on the YMDD mutation during lamivudine therapy in hepatitis B patients with different HBV genotypes

Objective To study the tyrosine-methionine-aspartate-aspartate（YMDD） mutation during lamivudine therapy in hepatitis B patients with different Hepatitis B virus（HBV） genotypes.Methods Real-time fluorescence polymerase chain reaction（PCR） and gene sequencing were used for the detection of HBV DNA levels,YMDD mutants and HBV genotypes in serum samples of 115 hepatitis B patients during lamivudine therapy.Results The HBV DNA positive rates in patients with lamivudine therapy time less than 12 months,12 to 24 months and more than 24 months were 75%,35% and 16%,and YMDD mutation rates were 22%,54% and 100%,respectively.Among 115 hepatitis B patients in Dalian,the proportions of genotype B,C and B-C mixed-type were 17%,75% and 8%,respectively.The YMDD mutation rates of genotype B and C were 21% and 19.5%.There was no YMDD mutation in patients with B-C mixed-type.It showed no significant correlation between HBV DNA genotypes and YMDD mutation rates（P0.05）.Conclusions During lamivudine therapy,there is no relation between the YMDD mutation and the HBV genotypes.