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探讨慢性乙型肝炎(Chronic hepatitis B,CHB)患者多聚酶基因逆转录保守区(P区)位点突变情况。选择212例行核苷(酸)类似物抗病毒治疗的CHB患者,采用PCR产物直接测序法检测HBV P基因区耐药变异位点,同时检测其HBV基因型。结果表明,HBV的P基因区突变位点有173、180、18l、184、204、236和250,主要的耐药位点为204和180,分别占35.8%和23.5%。180位点在不同年龄组之间比较均有显著差异,204位点在30岁以下组与41~50岁组、51~60岁组间比较有显著差异(P<0.05,P<0.01);180位点联合204位点突变率为66.6%,l81位点联合236位点突变率为23.3%;HBV C基因型患者年龄明显大于B基因型患者(P<0.01)。M204V/I多以联合L180M突变的形式存在,突变率与年龄有关,HBV基因型和HBV P区耐药位点的检测对CHB患者的治疗和病情预后具有重要的临床意义。
To investigate the mutation of polymerase chain reaction (P region) in patients with chronic hepatitis B (CHB). Two hundred and twelve patients with CHB treated with antiviral therapy of nucleoside (acid) analogues were selected. The PCR products were directly sequenced to detect the resistance mutation sites of HBV P gene region and HBV genotypes were detected. The results showed that there were 173, 180, 181, 184, 204, 236 and 250 mutations in the P gene region of HBV, and the major resistance sites were 204 and 180, accounting for 35.8% and 23.5% respectively. There was a significant difference between the age group of 180 and the age group of 204 (P <0.05, P <0.01). There was a significant difference between the age group of 204 and the age group of 41 ~ 50 and the age group of 51 ~ 60 years. The mutation rate of 180 locus and 204 locus was 66.6%, and the mutation rate of l81 locus and 236 locus was 23.3%. The age of HBV C genotype was significantly longer than that of B genotype (P <0.01). M204V / I mostly exist in the form of L180M mutation. The mutation rate is related to age. The detection of HBV genotypes and HBV P resistance sites has important clinical significance for the treatment and prognosis of CHB patients.