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目的研究承德地区HBV基因型与拉米夫定疗效及耐药变异关系。方法 58例入选慢性乙肝病人接受拉米夫定抗乙肝病毒治疗48周。比较治疗48周后HBV-DNA载量变化、ALT复常率、HBeAg血清转换率及耐药变异情况。采用FQ-PCR法进行HBV-DNA定量检测及HBV基因分型和YMDD变异检测。结果拉米夫定治疗48周后,大部分患者HBV-DNA载量、ALT复常率及HBeAg血清转换率较基线改善,且B、C两基因型间差异无统计学意义。在17例HBV-DNA反弹的患者中,16例检出YMDD变异,其中C型12例,B型4例。结论拉米夫定能明显抑制HBV复制,促进ALT复常和HBeAg血清转换。拉米夫定抑制HBV疗效与HBV基因型B型或C型无关。YMDD变异率在B、C基因型病人中无差别,但变异后基因型C病毒复制水平比基因型B要高。
Objective To study the relationship between HBV genotype and lamivudine efficacy and drug resistance mutation in Chengde area. Methods 58 cases of chronic hepatitis B patients received lamivudine anti-hepatitis B virus treatment for 48 weeks. HBV DNA load changes, ALT normalization rate, HBeAg seroconversion rate and drug resistance variation were compared 48 weeks after treatment. FQ-PCR method for HBV-DNA quantitative detection and HBV genotyping and YMDD mutation detection. Results After 48 weeks of lamivudine treatment, the HBV-DNA load, ALT normalization rate and HBeAg seroconversion rate of most patients improved compared with baseline, and there was no significant difference between B and C genotypes. Among 17 patients with HBV-DNA rebound, 16 patients were detected YMDD mutation, of which 12 were type C and 4 were type B. Conclusion Lamivudine can significantly inhibit HBV replication, promote ALT normalization and HBeAg seroconversion. Lamivudine inhibition of HBV efficacy and HBV genotype B or C has nothing to do. YMDD mutation rate in B, C genotype patients no difference, but after mutation genotype C virus replication level than genotype B is higher.