LAM单独及与ECV联合治疗CHB对不同基因型HBV耐药突变的影响

发布时间：2018-04-05 17:32

本文选题：慢性乙型肝炎　切入点：联合用药　出处：《山东医药》2015年45期

【摘要】：目的探讨拉米夫定(LAM)单独及与恩替卡韦(ECV)联合治疗慢性乙型肝炎(CHB)对不同基因型HBV耐药突变的影响。方法选择CHB患者100例,其中B基因型30例,C基因型70例。将患者随机分为联合用药组及单独用药组各50例,联合用药组每日口服LAM 50 mg和ECV 0.5 mg,单独用药组每日单用LAM 100 mg。治疗后24个月采用PCR-反向点杂交芯片法检测血清HBV基因型耐药突变情况及耐药基因变异类型。结果联合用药组检出耐药突变4例,检出率为8%,其变异类型分别为rt T184L+L180M+M204 V、rt T184 L+S202 G+L180 M+M204 I、rt M250 L+M204 I,其中C基因型3例(突变率为9.1%),B基因型1例(突变率为5.9%);单独用药组检出耐药突变25例,检出率为50%,其变异类型分别为rt L180M+M204 V、rt L180 M+M204 I、rt M204 I,其中C基因型18例(突变率为48.6%),B基因型7例(突变率为53.8%)。两组耐药突变检出率比较,P0.05,两组B型和C型基因的耐药突变率比较均无显著性差异。结论 LAM单用治疗CHB的耐药突变检出率明显高于与ECV联合治疗者,LAM单用及与ECV联合治疗对CHB不同基因型HBV耐药突变无明显影响。
[Abstract]:Objective to investigate the effect of lamivudine (lamivudine) alone and in combination with entecavir (ECV) on HBV resistance mutations in patients with chronic hepatitis B (CHB).Methods A total of 100 patients with CHB were selected, including 30 patients with genotype B and 70 patients with genotype C.The patients were randomly divided into two groups: 50 cases in combination group and 50 cases in single group. 50 mg LAM and 0.5 mg ECV were orally administered daily in combination group, and only 100 mg LAM was given daily in combination group.PCR- reverse dot hybridization (PCR- reverse dot hybridization) was used to detect the mutation of serum HBV genotypes and the mutation types of drug resistance genes at 24 months after treatment.Results the drug resistance mutation was detected in 4 cases in the combination group.The positive rate was 8. The variation types of Rt T184L L180M M204 Vrt T184 L S202 G L180 M 204 Irt M250 L M204 I were 3 cases of genotype C (the mutation rate was 9. 1% in 1 case, the mutation rate was 5. 9%), and the drug resistance mutation was detected in 25 cases in the single drug group.The positive rate was 50. The type of variation was RT L180M 204Vrt L180M 204ItM204I, of which 18 cases were genotype C (the mutation rate was 48.6%) and the mutation rate was 53.8% (P < 0.05).The detection rate of drug resistance mutation was compared between two groups (P 0.05). There was no significant difference between two groups in drug resistance mutation rate of type B gene and type C gene.Conclusion the detection rate of drug resistance mutation in CHB treated with LAM alone is significantly higher than that in patients treated with ECV alone or in combination with ECV. There is no significant effect on HBV resistance mutation in different genotypes of CHB.
【作者单位】：河北医科大学第一医院;
【基金】：河北省卫生厅科研立项课题(20130565)
【分类号】：R512.62

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