关键词: 肝炎，乙型，慢性；突变；替比夫定；焦磷酸测序

Abstract:

Objective     To study mutation patterns of telbivudine(LdT)-resistant in the HBV P gene and clinical features in patients with chronic hepatitis B(CHB). Methods     15 patients with hepatitis B e antigen (HBeAg)-positive CHB that had a virological breakthrough and LdT-resistent mutation confirmed by the pyro-sequencing method were retrospectively analyzed. Results     5 mutation patterns at 4 sites of LdT-resistant were detected, rtM204I in 9 cases, rtM204I+rtL180M in 3 cases, and rtM204I+rtV173L, rtM204I+rtV173L+rtL180M and rtM204I+rtV173L+rtA181V in each 1 case. Serum HBV-DNA levels of all the 15 patients were below 104 copies/mL after 24 weeks of LdT treatment, 60% (9/15) of which were below 103copies/mL. Resistant mutations were detected from 40 to 111 weeks and all patients failed to take on HBeAg seroconversion. Conclusions     RtM204I is the main mutation pattern of LdT-resistance. Resistant mutation should still be of concern for patients who fail to take on HBeAg sero-conversion even if serum HBV-DNA is below 103 copies/mL at week 24.

Key words: Hepatitis B, chronic; Telbivudine; Mutation; Pyrosequencing