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[目的]探讨拉米夫定治疗慢性乙型肝炎(CHB)引发乙型肝炎病毒(HBV)-YMDD变异,以及HBV-YM-DD变异与血清HBV-DNA、丙氨酸氨基转移酶(ALT)水平变化的关系。[方法]采用RT-PCR、ELISA方法检测86例CHB患者在拉米夫定治疗前及治疗12、24个月时HBV-YMDD变异情况,血清HBV-DNA和ALT水平。[结果]86例CHB患者在拉米夫定治疗前未检出HBV-YMDD变异,治疗12个月检出HBV-YMDD变异23例(26.74%)、24个月35例(40.70%);12个月及24个月HBV-YMDD变异组血清HBV-DNA阴转率分别为43.48%、31.43%,无变异组分别为57.14%、54.90%,2组阴转率比较差异有统计学意义(P<0.05)。拉米夫定治疗24个月后,HBV-YMDD变异组血清ALT为(42.71±14.27)U/L,无变异组为(25.55±11.41)U/L(P<0.05)。[结论]拉米夫定治疗CHB引发HBV-YMDD变异,其变异发生率随治疗时间的延长而上升,并伴有血清HBV-DNA转阴率的明显降低和ALT水平的反跳。
[Objective] To investigate the relationship between HBV-YM-DD mutation and serum HBV-DNA, alanine aminotransferase (ALT) in patients with chronic hepatitis B (CHB) The relationship between the level of change. [Methods] The HBV-YMDD mutation, serum HBV-DNA and ALT levels in 86 CHB patients before and 12 and 24 months of treatment were detected by RT-PCR and ELISA. [Results] No HBV-YMDD mutation was detected in 86 CHB patients before treatment with lamivudine, 23 (26.74%) HBV-YMDD mutations were detected in 12 months and 35 (40.70%) in 24 months. 12 The negative conversion rate of HBV-DNA in HBV-YMDD mutation group was 43.48% and 31.43% at month and 24 months respectively, 57.14% and 54.90% in non-mutation group, respectively <0.05). Serum ALT in HBV-YMDD mutation group was (42.71 ± 14.27) U / L after 24 months of treatment with lamivudine, and (25.55 ± 11.41) U / L in non-mutation group (P <0.05). [Conclusion] The HBV-YMDD mutation induced by lamivudine in CHB patients is increased with the increase of treatment time, accompanied by the marked decrease of serum HBV-DNA negative rate and the rebound of ALT level.