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目的观察拉米夫定治疗慢性乙型肝炎(CHB)YMDD变异的产生与血清病毒载量的关系。方法选择应用拉米夫定治疗并产生YMDD变异的CHB患者53例,分析血清病毒载量水平与YMDD变异类型、产生时间的关系。另选择具有可比性的应用拉米夫定治疗但并未产生YMDD变异的CHB患者53例(1∶1配对)对比分析治疗前血清HBVDNA定量水平。结果YMDD变异组治疗前血清HBVDNA定量水平显著高于未产生YMDD变异组(P<0.01)。YMDD变异类型与血清HBVDNA定量水平不相关(P>0.05),但YMDD变异产生时间与血清HBVDNA定量水平相关(P<0.05)。结论CHB患者血清病毒载量水平越高,应用拉米夫定治疗越容易产生YMDD变异,且产生时间越早。血清病毒载量可作为应用拉米夫定治疗YMDD变异产生的早期预测指标。YMDD变异类型与病毒载量不相关。
Objective To observe the relationship between lamivudine treatment of chronic hepatitis B (CHB) YMDD mutation and serum viral load. Methods Fifty-three CHB patients who were treated with lamivudine and had YMDD mutation were enrolled. The relationship between serum viral load level and YMDD mutation type and time were analyzed. In addition, 53 patients with CHB treated with lamivudine but no YMDD mutation (1: 1 paired) were selected to compare the serum HBVDNA levels before treatment. Results The level of serum HBV DNA in patients with YMDD mutation before treatment was significantly higher than that without YMDD mutation (P <0.01). The type of YMDD mutation was not correlated with the level of serum HBVDNA (P> 0.05), but the time of YMDD mutation correlated with the level of serum HBVDNA (P <0.05). Conclusion The higher serum viral load level in patients with CHB, the more likely to produce YMDD mutation after treatment with lamivudine, and the earlier the time of production. Serum viral load can be used as an early predictor of YMDD mutation in lamivudine therapy. The type of YMDD mutation is not related to the viral load.