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目的探讨慢性乙型肝炎(CHB)患者在服用拉米夫定后发生YMDD变异与否其HBV DNA与HBeAg定量值之间是否存在相关关系。方法聚合酶链反应(PCR)荧光定量法测定CHB患者治疗前后的HBV DNA、YMDD变异,同时微粒子酶免疫分析法检测其HBeAg定量值。结果218份标本同时检测HBV DNA和HBeAg定量值,对两指标前后两次的升降率进行相关性分析,发现无显著相关性(r=0.3153,P>0.05)。12例发生YMDD变异(变异组)和25例YMDD野生型(野生组)发生HBeAg血清转换者分别为3例和15例,差异有统计学意义(χ2=3.976,P<0.05);变异组和野生组HBV DNA对数值分别为(4.15±1.78)和(2.72±1.58),差异有统计学意义(P<0.01);变异组和野生组HBV DNA、HBeAg定量值分别做相关性分析,发现变异组r=0.5552,有显著相关性(P<0.05),野生组r=0.2683,无显著相关性(P>0.05)。结论拉米夫定抗病毒治疗过程中HBV DNA和HBeAg滴度变化无显著相关性,YMDD变异组血清转换率和持续转换率明显低于无变异组,HBV DNA和HBeAg始终维持在较高水平。
Objective To investigate whether YMDD mutation occurs in patients with chronic hepatitis B (CHB) after taking lamivudine or not and whether there is a correlation between HBV DNA and the quantitative value of HBeAg. Methods The HBV DNA and YMDD mutation in patients with CHB before and after treatment were determined by polymerase chain reaction (PCR) fluorescence quantitative method, and the quantitative value of HBeAg was detected by microparticle enzyme immunoassay. Results There were no significant correlations between 218 HBV DNA and HBeAg levels in 218 samples before and after the two indexes (r = 0.3153, P> 0.05). There were 3 cases and 15 cases of HBeAg seroconversion in 12 cases of YMDD mutation (mutation group) and 25 cases of YMDD wild type (wild group), respectively, with significant difference (χ2 = 3.976, P <0.05) The logarithmic values of HBV DNA in wild group were (4.15 ± 1.78) and (2.72 ± 1.58) respectively, with statistical significance (P <0.01). Correlation analysis of HBV DNA and HBeAg in wild group and wild group showed that mutation Group r = 0.5552, significant correlation (P <0.05), wild group r = 0.2683, no significant correlation (P> 0.05). Conclusion There was no significant correlation between HBV DNA and HBeAg titers during lamivudine antiviral therapy. The seroconversion rate and continuous conversion rate of YMDD mutation group were significantly lower than those of non-mutation group, and HBV DNA and HBeAg levels were always maintained at a high level.