乙肝拉米夫定治疗前后YMDD变异与DNA载量的关系-论文.pdf

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1、中华全科医学2014年10月第12卷第10期ChineseJournalofGeneralPractice，October2014，Vo1．12，No．10·1647··诊断技术一医学检验·乙肝拉米夫定治疗前后YMDD变异与DNA载量的关系彭定辉，柴红燕，熊陈岭，陈薇，胡汉宁，涂建成摘要：目的探讨原发性肝癌患者拉米夫定治疗前后HBVYMDD变异与HBVDNA复制水平的相关性，为临床治疗提供依据。方法应用实时荧光聚合酶链反应(PCR)技术检测72例原发性肝癌患者未服用拉米夫定治疗前血清HBVDNA载量以及服用拉米夫定

2、治疗12个月血清中YMDD突变情况。结果72例原发性肝癌患者中，出现YMDD变异者35例(48．6％)，其中YIDD变异者28例，YVDD变异者4例，YIDD和YVDD混合变异者3例。治疗后YMDD突变组HBVDNA载量显著高于YMDD野生组，拉米夫定治疗后YIDD及YIDD+YVDD杂合型的突变率明显增加，而对YVDD的突变率则有所降低。结论拉米夫定对原发性肝癌患者治疗前后HBVDNA复制水平无显著影响，而拉米夫定治疗后HBVDNA复制水平与YMDD突变具有相关性，可作为早期监测原发性肝癌HBVYMDD突变的观察

3、指标之一。关键词：HBVDNA载量；YMDD变异；原发性肝癌；聚合酶链反应中图分类号：R512．62R735．7文献标识码：A文章编号：16744152(2014)10—1647-02AnalysisontherelationshipbetweenYMDDmutationandthelevelsofHBVDNAinprimarylivercancerpa．tientsbeforeandafterlamivudinetreatmentPENGDing—hui。CHAIHong—yan．XIONcChen．1ing．e

4、ta1．Department0厂cfnalLaboratory，ZhongnanHospital，^anUniversity，Wuhan430071，Hubei，ChinaAbstract：ObjectiveToinvestigatetherelationshipbetweenYMDDmutationandHBVDNAreplicationlevelinprimarylivercancerpatients．toprovidethebasisforitsdiagnosisandtreatment．MethodsUsi

5、ngrea1．timefluorescencepolymer．asechainreaction(PCR)．thedetectionofHBVYMDDvariationandthelevelsofHBVDNAwasperformedamong60ca—sespatientswithprimarylivercancerbytreatedwithorwithoutlamivudinesernmfor12months．ResultsAmong72Da—tientswithprimarylivercancerpatients

6、．35caseswereYMDDmutation．includingtheYIDDvariationin28cases．YVDDvariationin4cases．YIDDandYVDDhybridmutationinthreecases．ThedetectionrateofYMDDmutationwas48．6％．TheHBVDNAlevelintheYMDDmutationgroupwassignificantlyhigherthanthoseintheYMDDwildgroupafterlami—vudine

7、treatment．Inaddition．themutationrateofYIDDandYIDD+YVDDheterozygoustypeincreasedsignificantlyaf-terthelamivudinetreatment．whilethemutationrateofYVDDdecreased．ConclusionLamivudinetreatmentlittleaffect—edtheHBVDNAlevelsamongstpatientswithprimarylivercancer．Howeve

8、r．thelevelofHBVDNAwasrelatedwiththeYMDDmutationdirectlyafterthetreatmentoflamivudine．socanbeusedasearlydetectionofHBVYMDDmutationa．mongstprimarylivercancerpatients．Keywords：HBVDNAl