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目的探讨乙型肝炎病毒前C区G1896A突变、基本核心启动子区A1762T、G1764A双突变与基因型、拉米夫定疗效的相关性。方法采用基因测序法对接受拉米夫定治疗的81例慢性重型乙型肝炎患者的血清标本进行前C区、基本核心启动子区(BCP区)、基因型及逆转录酶区(P区)检测,并对前C区、BCP区的变异与基因型、逆转录酶区的变异进行相关性分析。结果 81例慢性重型乙型肝炎患者送检标本中,68份标本可检出前C区G1896A变异或BCP区A1762T/G1764A变异;单纯G1896A突变31例,单纯A1762T/G1764A突变24例,前C区联合BCP区变异13例;81例慢性重型乙型肝炎患者经拉米夫定治疗后,有45例发生变异,其中180M和204V变异株35例,204I变异株10例;前C区变异在野生型组、变异型组中的检出率分别为38.9%、66.7%,两者差异有统计学意义(P<0.05);BCP区变异在野生型组、变异型组中的检出率分别为33.3%、55.6%,两者差异有统计学意义(P<0.05);在81例慢性重型乙型肝炎患者血清标本中,B基因型18例,C基因型63例;前C区变异在B、C基因型中的检出率分别为72.2%、33.3%,两者差异有统计学意义(P<0.05);BCP区变异在B、C基因型中的检出率分别为16.7%、54.0%,两者差异有统计学意义(P<0.05);G1896A突变在B基因型感染者中检出率明显高于C基因型感染者;A1762T/G1764A双突变在B基因型感染者中检出率明显低于C基因型感染者。结论发生G1896A突变和A1762T/G1764A突变的患者,在接受拉米夫定治疗后更易发生逆转录酶区的变异;G1896A突变易出现在B基因型感染者中,A1762T/G1764A突变易出现在C基因型感染者中。
Objective To investigate the relationship between hepatitis B virus precore G1896A mutation, basic core promoter region A1762T, G1764A double mutation and genotype and lamivudine efficacy. Methods Serum samples from 81 patients with chronic severe hepatitis B who underwent lamivudine treatment were enrolled in this study. Pre-C region, basic core promoter region (BCP region), genotype and reverse transcriptase region (P region) The correlation between the variation of pre-C region and BCP region and the genotype and the variation of reverse transcriptase region was analyzed. Results Among the 81 patients with chronic severe hepatitis B, 68 samples could detect the G1896A mutation in the pre-C region or the A1762T / G1764A mutation in the BCP region. Thirty-one G1896A mutations, 24 A1762T / G1764A mutations, There were 13 cases of mutation in BCP area and 45 cases of 81 cases of chronic severe hepatitis B after lamivudine treatment. There were 35 cases of 180M and 204V mutation and 10 cases of 204I mutation. (P <0.05). The detection rates of BCP mutation in wild-type group and variant group were 38.9% and 66.7% respectively, the difference was statistically significant 33.3% and 55.6%, respectively. There were significant differences between the two groups (P <0.05). Among the 81 patients with chronic severe hepatitis B, there were 18 cases of B genotype and 63 cases of C genotype. (P <0.05). The detection rates of BCP mutation in B and C genotypes were 16.7% and 54.0% respectively, the detection rates in C and C genotypes were 72.2% and 33.3%, respectively %, Respectively. The difference between the two groups was statistically significant (P <0.05). The positive rate of G1896A mutation in B genotype was significantly higher than that in C genotype. The A1762T / G1764A double mutation in B genotype It was significantly lower than those detected in genotype C infection. Conclusions Patients with G1896A mutation and A1762T / G1764A mutation are more prone to reverse transcriptase mutation after treatment with lamivudine. G1896A mutation is more likely to occur in patients with B genotype. A1762T / G1764A mutation is more likely to occur in C gene Infected persons.