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目的分析HBV P基因区核苷(酸)类似物相关10个位点的变异情况。方法采用焦磷酸测序法对NA治疗并发生病毒学突破或不充分病毒学应答的慢性乙型肝炎患者HBV P基因区10个位点(rtI169T、rtV173L、rtL180M、rtA181V/T、rtT184G、rtA194T、rtS202I、rtM204V/I、rtN236T、M205V)进行检测。结果拉米夫定(LAM)耐药48例,4个耐药位点呈8种模式,以rtM204为主;阿德福韦酯(ADV)10例,2个耐药位点呈4种模式,以rtA181为主;替比夫定(LdT)4例,2个耐药位点呈2种模式,均存在rtM204I;恩替卡韦(ETV)6例,7个耐药位点呈4种模式,以rtT184多见。结论应用NA可筛选出HBV P基因区的相关耐药变异,建议病毒突破患者检测耐药并行个体化治疗。
Objective To analyze the variation of 10 sites related to nucleoside (acid) analogs in HBV P gene region. Methods Pyrosequencing was performed on 10 sites of HBV P gene (rtI169T, rtV173L, rtL180M, rtA181V / T, rtT184G, rtA194T, rtS202I) in patients with chronic hepatitis B who were treated with NA and had virological breakthrough or inadequate virological response. , RtM204V / I, rtN236T, M205V). Results 48 cases were resistant to lamivudine (LAM), 4 were resistant to 8 modes, with rtM204 as the main drug, 10 cases with adefovir dipivoxil (ADV) and 4 drug resistant sites , Mainly rtA181; telbivudine (LdT) in 4 cases, two drug resistance sites in two modes, there are rtM204I; entecavir (ETV) in 6 cases, seven resistance sites in four modes to rtT184 more common. Conclusion The application of NA can be screened out HBV P gene region related resistance mutations, recommended virus breakthrough in patients with drug-resistant parallel individualized treatment.