Acute exacerbation and hepatitis B virus clearance after emergence of YMDD motif mutation during lamivudine therapy
Acute exacerbation and hepatitis B virus clearance after emergence of YMDD motif mutation during lamivudine therapy
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DOI：
10.1002/hep.510300221
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发表时间：
1999-08-01
期刊：
影响因子：
13.5
通讯作者：
Chu, CM
中科院分区：
文献类型：
--
作者：
Liaw, YF;Chien, RN;Chu, CM
拉米夫定是一种有效的乙型肝炎病毒（HBV）复制抑制剂，但其长期使用可能与HBV酪氨酸-蛋氨酸-天冬氨酸-天冬氨酸（YMDD）基序突变有关。为了检查YMDD突变出现后的临床特征和病程，我们对在我单位接受拉米夫定治疗超过104周的SS患者进行了YMDD突变检测，其中32例发现有YMDD突变。他们继续拉米夫定治疗，如果临床有指示，每周或每两周随访一次，其中30人（93.7%）出现谷丙转氨酶（ALT）升高，13人（40.6%）在出现YMDD突变体后4至94周（中位，24周）出现急性加重。无YMDD突变患者的加重发生率远高于4.3% （P = 0.003）。与未加重的患者相比，加重患者在出现YMDD突变体后血清HBV-DNA水平显著升高(P
Lamivudine is a potent inhibitor of hepatitis B virus (HBV) replication, but its long-term use may be associated with HBV tyrosine-methionine-aspartate-aspartate (YMDD) motif mutation. To examine the clinical features and course after emergence of YMDD mutants, SS patients who received lamivudine therapy over 104 weeks at our unit were assayed for YMDD mutation(s), Thirty-two of them were found to have the YMDD mutation. They continued lamivudine therapy and were followed up weekly or biweekly if clinically indicated, Thirty (93.7%) of them showed elevation of alanine transaminase (ALT), and 13 (40.6%) experienced acute exacerbation at 4 to 94 weeks (median, 24 weeks) after emergence of the YMDD mutant. The incidence of exacerbation is much higher than 4.3% in patients without the YMDD mutation (P = .003). Compared with patients without exacerbation, patients with exacerbation had a significantly higher serum HBV-DNA level after emergence of the YMDD mutant (P