拉米夫定治疗慢性乙型病毒性肝炎患者YMDD变异及影响因素

目的：探讨慢性乙型病毒性肝炎患者应用拉米夫定治疗后YMDD变异发生率及其影响因素。方法将90例慢性乙肝患者根据治疗方法的不同分为观察组和对照组，对照组应用拉米夫定，观察组应用拉米夫定及干扰素，测定并观察患者治疗前、治疗过程中的HBV DNA载量，血清ALT水平，并分析ALT水平与HBV DNA载量与YMDD变异率的相关性。结果①单用拉米夫定治疗的患者在治疗6个月后YMDD变异的累计发生率明显高于拉米夫定联合干扰素治疗的患者（P〈0.05）；②未联合应用干扰素、ALT水平〈80 U/L、HBV DNA载量〉1.0×10^3 copy/ml是影响YMDD变异的独立危险因素（P〈0.05）；③ALT水平与YMDD变异率呈负相关（r=-0.62，P〈0.05），HBV DNA水平与YMDD变异率呈正相关（r=0.85，P〈0.05）。结论未联合应用干扰素、ALT水平低以及HBV DNA载量高是慢性乙型病毒性肝炎患者YMDD变异的影响因素，并且ALT水平及HBV DNA载量与YMDD变异率成相关性；临床医师应当通过ALT水平及HBV DNA载量进行指导用药。

YMDD virus mutation of patients with chronic hepatitis B treated by Lamivudine and its influence factors

Objective To investigate the YMDD virus mutation of patients with chronic hepatitis B treated by Lamivudine and its influence factors. Methods Ninety patients of chronic hepatitis B were divided into the obser-vation group and the control group according to the different treatment methods. The control group was treated with la-mivudine, and the observation group was treated with lamivudine and interferon. HBV DNA load, serum ALT level be-fore and after treatment were compared. Correlations among ALT level, HBV DNA load and the YMDD variation were an-alyzed. Results ①Six months after treatment, the cumulative incidence of YMDD mutation was significantly higher in the control group than that of the observation group （P〈0.05）. No combination of interferon, ALT 〈80 U/L, HBV DNA load of〉1.0×10^3 copy/ml were the independent risk factors of YMDD mutation （P〈0.05）. The levels of ALT and YMDD mutation rate were negatively correlated （r=-0.62, P〈0.05）. HBV DNA levels were positively correlated with YMDD mutation rate （r=0.85, P〈0.05）. Conclusion The combined application of interferon, low levels of ALT and high HBV DNA load are factors in patients of chronic hepatitis B with YMDD mutation, and ALT level, HBV DNA load are positively correlated with YMDD variation. Clinicians should give medication guide based on the ALT level and HBV DNA load.