拉米夫定耐药株诱导的急性乙型肝炎患者的流行状况及临床特征。

Prevalence and clinical characterization of patients with acute hepatitis B induced by lamivudine-resistant strains.

机构信息

Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

出版信息

J Gastroenterol Hepatol. 2010 Apr;25(4):745-9. doi: 10.1111/j.1440-1746.2009.06118.x. Epub 2010 Jan 13.

DOI:10.1111/j.1440-1746.2009.06118.x

PMID:20074155

Abstract

BACKGROUND AND AIMS

Acute hepatitis caused by lamivudine (LMV)-resistant strains has not been reported, and the clinical impact of LMV-resistant strains on acute hepatitis is not known. The aim of this study was to investigate the molecular and clinical characteristics of patients with acute hepatitis B caused by LMV-resistant strains.

METHODS

Forty-five patients with acute hepatitis B were studied. Hepatitis B virus (HBV) subgenotypes and LMV-resistance mutations were determined by direct sequencing of the preS and polymerase regions, respectively.

RESULTS

HBV subgenotypes A2 (n = 18), B1 (n = 1), B2 (n = 3), B3 (n = 2), C1 (n = 1), C2 (n = 19) and C6 (n = 1) were detected in patients with acute hepatitis. LMV-resistance mutations were detected in two patients. LMV-resistance mutations (L180M, M204I) were detected in a patient with subgenotype C2 who had acute self-limited hepatitis. The other patient with LMV-resistance mutations (L180M, M204V) was infected with subgenotype A2 and had severe hepatitis.

CONCLUSION

LMV-resistant strains are rare, but they are starting to be found in patients with acute hepatitis B. Surveillance for detecting drug-resistant HBV strains would be important for clinical practice.

摘要

背景与目的

拉米夫定（LMV）耐药株引起的急性肝炎尚未见报道，且 LMV 耐药株对急性肝炎的临床影响尚不清楚。本研究旨在探讨 LMV 耐药株引起的急性乙型肝炎患者的分子和临床特征。

方法

对 45 例急性乙型肝炎患者进行研究。通过直接测序前 S 和聚合酶区分别确定乙型肝炎病毒（HBV）亚基因型和 LMV 耐药突变。

结果

在急性肝炎患者中检测到 HBV 亚基因型 A2（n = 18）、B1（n = 1）、B2（n = 3）、B3（n = 2）、C1（n = 1）、C2（n = 19）和 C6（n = 1）。在两名患者中检测到 LMV 耐药突变。在一名亚基因型 C2 的自限性急性肝炎患者中检测到 LMV 耐药突变（L180M、M204I）。另一名 LMV 耐药突变（L180M、M204V）患者感染亚基因型 A2，患有重症肝炎。