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目的研究慢性乙型肝炎患者应用拉米夫定治疗前与治疗一年期间的乙肝病毒YMDD变异情况。方法103例接受拉米夫定治疗的慢性乙型肝炎患者,在开始治疗前和治疗第1、4、8个月以及1年时采集患者外周血,提取乙型肝炎病毒DNA,采用单核苷酸多态性分析方法,进行短核苷酸片段测序分析。结果乙型肝炎病毒DNA多聚酶区,使用拉米夫定治疗前,发生YVDD变异者1例,发生YIDD变异者2例;治疗第1月,发生YVDD变异者2例,发生YIDD变异者2例;治疗第4月,发生YVDD变异者3例,发生YIDD变异者4例;治疗第8月,发生YVDD变异者6例,发生YIDD变异者8例;治疗1年时,发生YVDD变异者11例,发生YIDD变异者13例。结论在进行拉米夫定治疗前,乙型肝炎病毒即有变异情况发生,随拉米夫定治疗变异率增加治疗1年时,乙型肝炎病毒发生变异率最高。
Objective To study the variation of YMDD of hepatitis B virus in patients with chronic hepatitis B before and during one year of treatment with lamivudine. Methods A total of 103 patients with chronic hepatitis B who received lamivudine treatment were enrolled in the study. Peripheral blood samples were collected before treatment, 1, 4, 8 months and 1 year after treatment. Hepatitis B virus DNA was extracted and mononucleoside Acid polymorphism analysis method, short nucleotide sequencing analysis. Results In the hepatitis B virus DNA polymerase region, there were 1 case of YVDD mutation and 2 cases of YIDD mutation before treatment with lamivudine. In the first month of treatment, 2 cases had YVDD mutation and 2 cases had YIDD mutation. In the fourth month of treatment, 3 cases had YVDD mutation and 4 cases had YIDD mutation; in the 8th month of treatment, 6 cases had YVDD mutation and 8 cases had YIDD mutation; in the one year after treatment, 11 cases had YVDD mutation, 13 cases occurred YIDD mutation. Conclusion Before the treatment of lamivudine, the mutation of hepatitis B virus occurs. With the increase of mutation rate of lamivudine treatment for 1 year, the mutation rate of hepatitis B virus is the highest.