Tokgöz Yavuz, Terlemez Semiha, Sayan Murat, Kırdar Sevin
Departments of Pediatric Gastroenterology, Hepatology and Nutrition, Adnan Menderes University Faculty of Medicine, Aydın, Turkey.
Departments of Pediatric Cardiology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey.
Turk J Pediatr. 2018;60(5):514-519. doi: 10.24953/turkjped.2018.05.007.
Tokgöz Y, Terlemez S, Sayan M, Kırdar S. Investigation of antiviral resistance and escape mutations in children with naive chronic hepatitis B patients and their parents. Turk J Pediatr 2018; 60: 514-519. In this study, it was aimed to scan the resistance to nucleoside analogs in naive pediatric patients with chronic hepatitis B treatment and their parents and the rate of accompanying possible escape mutations. A total of 34 children who did not receive any treatment regarding chronic hepatitis B and 19 parents who caused vertical transmission or acquired transmission from father were involved in the study. Serological tests concerning hepatitis B virus and transaminases in conjunction with viral load were studied. HBV genotypes, subgenotypes were determined by surface gene sequencings. The gene mutations coding polymerase (pol) for resistance against nucleoside analogs and escape mutations in the genes coding surface (S) proteins were analyzed with PCR method. All cases were genotype D. Only one pediatric patient was D2; the rest of all pediatric patients and their parents were genotype D1. Resistance was not identified against nucleoside analogs in any children or their parents. HBsAg escape mutations determined in the chronic hepatitis B patients were 18.8% (10 case). It can be speculated with this results that the resistance may not be considered as a problem in the preference of nucleoside analogs in treatment of naive children. Nevertheless, escape mutations were seen as high in both children and parents as well. Since it interests public health on a large scale, advanced studies and evaluation of vaccination escape mutations` rate in broad case series and their follow up are of great importance in the determination of health policies with regard to hepatitis B infection control.
托克戈兹Y、特尔勒梅兹S、萨扬M、基尔达尔S。初治慢性乙型肝炎患儿及其父母抗病毒耐药性和逃逸突变的研究。《土耳其儿科学杂志》2018年；60:514 - 519。本研究旨在检测初治慢性乙型肝炎患儿及其父母对核苷类似物的耐药性以及伴随可能的逃逸突变的发生率。共有34例未接受过任何慢性乙型肝炎治疗的儿童以及19例通过垂直传播或从父亲获得传播的父母参与了该研究。研究了与病毒载量相关的乙型肝炎病毒血清学检测和转氨酶。通过表面基因测序确定HBV基因型、亚基因型。采用PCR方法分析编码针对核苷类似物耐药的聚合酶（pol）的基因突变以及编码表面（S）蛋白的基因中的逃逸突变。所有病例均为D基因型。仅1例患儿为D2；其余所有患儿及其父母均为D1基因型。在任何儿童或其父母中均未发现对核苷类似物的耐药性。慢性乙型肝炎患者中确定的HBsAg逃逸突变率为18.8%（10例）。根据这些结果可以推测，在初治儿童的治疗中选择核苷类似物时，耐药性可能不被视为一个问题。然而，在儿童和父母中逃逸突变率也都很高。由于其在很大程度上关乎公共卫生，在广泛病例系列中对疫苗逃逸突变率进行进一步研究和评估及其随访，对于制定关于乙型肝炎感染控制的卫生政策非常重要。
