拉米夫定耐药慢性乙型肝炎患者HBV多聚酶区基因突变分析

目的探讨拉米夫定（LAM）耐药慢性乙型肝炎（CHB）患者多聚酶区序列突变特点。方法收集63例接受拉米夫定治疗且耐药的CHB患者的临床资料,采用PCR产物直接测序法检测HBVP基因多聚酶区序列耐药变异。结果 63例诊断为耐药的患者中,51例患者检测到LAM相关的HBV多聚酶区基因突变,其中rtM204V/I变异46例（73.0%）,rtL180M变异25例（39.7%）,rtV173L/M变异5例（7.9%）,rtQ214E变异1例（1.6%）,rtS213T变异2例（2.%）12,rtV207L/M/I变异2例（3.2%）,rtA181T变异3例（4.8%）,rtT184I/S/M变异1例（1.6%）。结论对拉米夫定治疗患者的耐药检测除HBV多聚酶区常见的rtLl80M和rtM204V/I位点变异外,还应考虑其他位点的耐药变异。

Analysis of HBV Polymerase Gene Mutation of Patients with Hepatitis B Resistant to Lamivudine

Objective：To investigate the characteristics of HBV polymerase gene mutation of patients with hepatitis B resistant to lamivudine.Methods 63 CHB patients who receiving lamivudine therapy and resistant to lamivudine.Direct sequencing of the PCR products was used to detect LAM genotypic resistance.Results 63 patients with CHB were diagnosed as LAM-resistant patients.51 patients were found to have LAM-associated mutations in the HBV polymerase gene.RtM204V/I mutations is 73.0%（46/51）,rtL180M mutations is 39.7%（25/51）,rtV173L/M mutations is 7.9%（5/51）,rtQ214E mutations is 1.6%（1/51）,rtS213 mutations is 3.2%（2/51）,rtV207L/M/I mutations is 3.2%（2/51）,rtA181T mutations is 4.8%（3/51）,rtT184I/S/M mutations is 1.6%（1/51）.Conclusions The detection of lamivudine resistance in patients,in addition to rtLl80M mutations and rtM204V/I mutations,we should also consider other sites of resistance mutations.