关键词: 乙型肝炎, HBV基因型, 核苷（酸）类似物, 突变

Abstract: Objective To investigate the distribution characteristics of hepatitis B virus genotypes in patients with CHB or hepatitis B cirrhosis,and to explore the mutants patterns in HBV P gene sequences during nucleos（t）ide analogue（NAs） treatment. Methods 39 patients with CHB or hepatitis B cirrhosis observed drug resistance or suspected drug resistance were enrolled. Serum HBV DNA levels was detected by real time PCR, and then sequenced and compared with standard sequence in HBVseq datebase. Results The genotypes of HBV in 34（87.2%） patients were observed,and the genotype C was found in 32（82.1%）,and genotype B in 2 （5.1%）. 27（69.2%） of 39 patients were observed carrying mutation in RT gene sequence;point mutations accounted for 30.8%,including 6 harboring rtM204I/V/（15.4%）,2 harboring rtA181V/T（5.1%）,and 4 harboring rtI169T （10.3%）,and combination mutations were 38.4%;there were 23 patients detected to be resistant to NAs. 8 patients were resistant to adefovir dipivoxil（ADV）,and among them,one was genotype B,and the other 7 were genotype C,harboring rtA181V/T/S,rtV214A/E or rtN236T;11 patients were resistant to both lamivudine（LAM） and telbivudine （LDT） with genotype C,harboring rtM204I/V/S or rtL180M;3 patients were resistant to LAM,LDT and entecavir（ETV）,and they were all with genotype C;1 patient with type C was resistant to LAM, LDT and ADV, and the mutation pattern was rtM204I/V/S+rtA181V/T/S+rtL180M. Conclusion HBV P mutations exist in most patients with chronic hepatitis B;the rtM204I/V/S mutations is the dominate mutation pattern,and different NAs may share the common mutations.

Key words: Hepatitis B, HBV genotypes, Nucleos（t）ide analogues, Mutation