新疆和田地区维吾尔族与汉族慢性乙型肝炎患者病毒耐药性比较研究*

doi:10.3969/j.issn.1672-5069.2017.01.008

摘要/Abstract

摘要： 目的探讨新疆和田地区维吾尔族和汉族慢性乙型肝炎（CHB）患者耐药性差异。方法随机选取2015年3月~2016年1月收治的接受拉米夫定（LAM）和/或阿德福伟（ADV）治疗的CHB患者1288例,其中维吾尔族1218例,汉族70例。采用DNA微阵列芯片技术检测血清HBV rt L180M、rtM204I/V、rtA181T/V和rtN236T四个耐药突变位点。结果汉族CHB患者HBV基因型耐药比例为25.7%,显著高于维吾尔族患者的18.3%（P=0.014）;维吾尔族CHB患者男女比例为1019/199,汉族为57/13,两组性别比无显著性差异（P=0.087）,但在耐药基因阳性者中,维吾尔族男性比例显著高于汉族（P=0.039）;在基因型耐药患者中,维吾尔族CHB患者血清HBV DNA水平为（5.3±0.9） lg copies/ml,显著低于汉族患者的（6.1±0.7） lg copies/ml,差异有统计学意义（P=0.012）;维吾尔族基因耐药患者血清ALT水平为（157.6±25.9） U/L、AST为（67.1±13.2） U/L、TBIL为（41.8±11.6）μmol/L,均显著低于汉族[分别为（203.7±45.1） U/L、（85.9±22.7） u/L、（57.4±13.5）μmol/L,差异均有统计学意义（P<0.05或P<0.01）];维吾尔族患者和汉族患者年龄分别为（37.9±10.8）岁和（38.8±12.1）岁,无明显差异（P>0.05）;维吾尔族和汉族患者血清HBeAg阳性率分别为14.3%和18.6%,无明显差异（P=0.061）;在241例维吾尔族和汉族基因型耐药患者中,均检测出LAM和DAV的4个耐药变异位点的6种突变,分别为rtL180M、rtM204I、rtM204V、rtA180T、rtA180V和rtN236T;维吾尔族和汉族患者rtA1181T/V点位阳性率分别为18.4%和16.7%（P>0.05）,而维吾尔族患者rtA1181T/V点位阳性率显著高于汉族患者,差异有统计学意义（P<0.05）;维吾尔族和汉族患者rtL180M、rtM204I/V、rtN236T点位阳性率分别为38.6%和38.9%、27.4%和27.8%、15.7%和16.7%,差异无统计学意义（P>0.05）。结论汉族患者存在HBV基因耐药比例更高,维吾尔族男性变异比例显著高于汉族,汉族患者出现变异时血清HBV DNA、ALT、AST、TBIL水平更高,两组患者在rtA181T/V位点存在显著性差异,其他位点未见明显差异。

关键词: 慢性乙型肝炎, 维吾尔族, 汉族, 核苷（酸）类似物, 耐药

Abstract: Objective To investigate the differences of drug resistance between Uygur and Han patients with chronic hepatitis B in Hetian prefecture,Xinjiang Uygur autonomous region. Methods 1218 Uygur and 70 Han patients with chronic hepatitis B（CHB） receiving lamivudine （LAM） and/or adefovir （ADV） between March 2015 and January 2016 were admitted to Infectious Disease Hospital,Hetian prefecture,Xinjiang Uygur autonomous region. The rt L180M, rtM204I/V,rtA181T/V and rtN236T mutation of HBV were detected by DNA microarray. Results The proportion of drug-resistant HBV infection in Han patients with CHB was 25.7%,much higher than 18.3% in Uygur patients（P=0.014）;the proportion of men and women in Uygur patients with CHB was 1019/199,while the proportion in Han patients with CHB was 57/13（P=0.087）;the ratio of Uygur men with resistance-positive HBV infection was significantly higher than in Han（P=0.039）;serum HBV DNA levels in Uygur patients with HBV mutation was [（5.3±0.9）lg copies/ml],much lower than in Han[（6.1±0.7） lg copies/ml,P=0.012];in Uygur patients with genotypic resistance,serum ALT level was （157.6±25.9） u/L,AST was （67.1±13.2） U/L and bilurubin was （41.8±11.6） μmol/L,much lower than in Han patients[（203.7±45.1） U/L,（85.9±22.7） U/L,（57.4±13.5） μmol/L，respectively，P<0.05 or P<0.01]；the average age in Uygur and Han patients were（37.9±10.8） yr and （38.8±12.1） yr，without significant difference （P>0.05）；serum HBeAg positive rates in Uygur and Han patients were 18.6% and 14.3%，without significant difference（P=0.061）；rtL180M，rtM204I，rtM204V，rtA180T，rtA180V and rtN236T mutation of LAM and/or ADV were detected positive in 241 Uygur and Han patients. The rtA1181T/V in positive rates in Uygur and Han patients were 18.4% and 16.7%，respectively，（P>0.05），while the rtA1181T/V in Uygur patients was higher than in Han patients（P<0.05）；the rtL180M，rtM204I/V，and rtN236T positive rates in Uygur and Han patients were 38.6% and 38.9%，27.4% and 27.8%，and 15.7% and 16.7%，respectively，without significant differences（P>0.05）. Conclusion Han patients with CHB have a higher proportion of drug-resistant，and Uygur male proportion is relatively higher in patients with viral mutation. Serum HBV DNA，ALT AST and bilirubin levels are higher in Han patients with CHB. There is a significant difference in rtA181T/V mutation between the two groups.

Key words: Chronic hepatitis B, Uygur, Han, Viral resistance

张剑, 买买提江·吾布力艾山, 李俊红. 新疆和田地区维吾尔族与汉族慢性乙型肝炎患者病毒耐药性比较研究^*[J]. 实用肝脏病杂志, 2017, 20(1): 25-28.

Zhang Jian, Maimaiti Jiang. Wubuliaishan, Li Junhong.. Differences of drug resistance between Uygur and Han patients with chronic hepatitis B in Hetian prefecture, Xinjiang[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2017, 20(1): 25-28.

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新疆和田地区维吾尔族与汉族慢性乙型肝炎患者病毒耐药性比较研究^*

Differences of drug resistance between Uygur and Han patients with chronic hepatitis B in Hetian prefecture, Xinjiang

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