Lai Ching-Lung, Dienstag Jules, Schiff Eugene, Leung Nancy W Y, Atkins Mark, Hunt Christine, Brown Nathaniel, Woessner Mary, Boehme Richard, Condreay Lynn
University Department of Medicine, Queen Mary Hospital, Hong Kong, People's Republic of China.
Clin Infect Dis. 2003 Mar 15;36(6):687-96. doi: 10.1086/368083. Epub 2003 Mar 5.
YMDD variants of hepatitis B virus (HBV) emerge in some patients with chronic hepatitis B who receive lamivudine. YMDD variants were examined in 794 patients in 4 controlled studies of 1 year's duration. The long-term effects of YMDD variants were examined in a subset of patients treated up to 4 years. YMDD variants were detected by polymerase chain reaction (PCR) and restriction fragment-length polymorphism assays. After 1 year, YMDD variants were detected in 81 (24%) of 335 patients. In these patients, the median serum HBV DNA concentration at 1 year was <20% of the baseline level, and serum alanine transaminase (ALT) levels and liver histologic findings had significantly improved. In patients with YMDD variants who were treated for up to 4 years, median HBV DNA and ALT levels showed improvements. Sex, baseline body mass index, and HBV DNA level were associated with emergence of YMDD variants. Patients with YMDD variants losing clinical response with a significant increase in the HBV DNA and ALT levels may require additional therapy.
乙肝病毒（HBV）的YMDD变异体出现在一些接受拉米夫定治疗的慢性乙型肝炎患者中。在4项为期1年的对照研究中，对794例患者进行了YMDD变异体检测。在一组接受治疗长达4年的患者中研究了YMDD变异体的长期影响。通过聚合酶链反应（PCR）和限制性片段长度多态性分析检测YMDD变异体。1年后，在335例患者中的81例（24%）检测到YMDD变异体。在这些患者中，1年时血清HBV DNA浓度中位数为基线水平的<20%，血清丙氨酸转氨酶（ALT）水平和肝脏组织学检查结果有显著改善。在接受治疗长达4年的YMDD变异体患者中，HBV DNA和ALT水平中位数有所改善。性别、基线体重指数和HBV DNA水平与YMDD变异体的出现有关。出现临床应答丧失且HBV DNA和ALT水平显著升高的YMDD变异体患者可能需要额外治疗。
