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为了监测拉米夫定临床治疗过程中耐药性的产生 ,更好地指导临床用药。采用 PCR产物克隆后测序的方法 ,对 2 0例服用拉米夫定病人进行随访观察 ,检测其体内乙型肝炎病毒 (HBV)聚合酶基因 (P gene) )酪氨酸 -蛋氨酸 -天门冬氨酸 -天门冬氨酸 (YMDD)区域变异情况 ,同时观察其 HBV DNA定量和肝功能指标变化。结果发现 ,1例病人在服用拉米夫定 9个月时出现 HBV YMDD变异株 ,并由混合感染逐渐进展为单一的变异株感染 ,出现耐药时伴有 HBV DNA定量反跳和 AL T的上升。表明拉米夫定长期治疗 (>6个月 )可能出现耐药 ,耐药变异株由弱势株逐渐演变为优势株 ,耐药出现时可伴有 HBV DNA定量和肝功能的变化
In order to monitor the clinical course of lamivudine drug resistance, to better guide clinical medication. Twenty cases of patients taking lamivudine were followed up and the gene of HBV polymerase gene (P gene) was detected by the method of PCR product cloning and sequencing. The tyrosine-methionine-aspartate Acid-aspartate (YMDD) regional variation, while observing its HBV DNA quantitative and liver function changes. The results showed that 1 patient in the lamivudine 9 months when the emergence of HBV YMDD mutant, and gradually developed from mixed infection as a single mutant infection, there is resistance with HBV DNA quantitative rebound and ALT rise. The results showed that the long-term treatment of lamivudine (> 6 months) may appear resistant, drug-resistant mutant gradually evolved from the disadvantaged strain dominant strains, resistance may be associated with HBV DNA quantitative and liver function changes