Ghandehari Freshte, Pourazar Abasali, Zadeh Mehrnaz Shanehsaz, Tajedin Nahid
Department of Microbiology and Genetics, Islamic Azad University Fellavarjan Branch, Isfahan, Iran.
Asian J Transfus Sci. 2011 Jan;5(1):32-4. doi: 10.4103/0973-6247.75982.
Lamivudine is an analog nucleoside used for the treatment of chronic hepatitis B virus (CHV) infection. Studies showed that prolonged therapy could induce lamivudine resistance hepatitis B virus (HBV) variants (YMDD motif). In this study, the rate of YMDD motif mutants is determined in lamivudine-treated CHV patients in Iran.
Thirty-three serum specimens of patients with chronic hepatitis who had been treated with lamivudine were included in the study. Serum samples of patients were tested by PCR flash and RFLP as well as tested for HBeAg, HBsAg, and liver enzymes (ALT and AST).
Out of the 33 patients enrolled in this study, 82% were male and 18% female, respectively. Mean ALT levels were between 20 and 100 IU/1. HBeAg was positive in 76% of the patients whereas HBs was positive only in 61% of the patients. Furthermore, in 28 patients liver biopsy grade was between 2 and 17 having the stage of 1-6. Moreover, HBsAg negative and HBeAg positive were observed in 30% of the patients.
During therapy, it was found that patients with lamivudine incidence YMDD mutation were approximately 14%. The ALT levels were also reduced in these patients. This study revealed that there was a significant difference between HBeAg, grade, and YMDD mutation whereas no significant different was observed between HBsAg and HBV DNA PCR. Conclusively, it was found that a significant difference exists between YMDD mutation and lamivudine therapy (17% of patients were HBsAg negative and PCR positive).
拉米夫定是一种用于治疗慢性乙型肝炎病毒（CHV）感染的核苷类似物。研究表明，长期治疗可诱导拉米夫定耐药的乙型肝炎病毒（HBV）变异体（YMDD基序）。在本研究中，测定了伊朗接受拉米夫定治疗的CHV患者中YMDD基序突变体的发生率。
本研究纳入了33例接受拉米夫定治疗的慢性肝炎患者的血清标本。通过PCR荧光法和RFLP检测患者的血清样本，并检测HBeAg、HBsAg和肝酶（ALT和AST）。
本研究纳入的33例患者中，男性占82%，女性占18%。平均ALT水平在20至100 IU/1之间。76%的患者HBeAg呈阳性，而仅61%的患者HBs呈阳性。此外，28例患者的肝活检分级在2至17级之间，分期为1至6期。此外，30%的患者HBsAg阴性而HBeAg阳性。
在治疗期间，发现拉米夫定发生YMDD突变的患者约为14%。这些患者的ALT水平也有所降低。本研究表明，HBeAg、分级和YMDD突变之间存在显著差异，而HBsAg和HBV DNA PCR之间未观察到显著差异。总之，发现YMDD突变与拉米夫定治疗之间存在显著差异（17%的患者HBsAg阴性且PCR阳性）。
