Xác định đột biến kháng Lamivudine của virus viêm gan B bằng kỹ thuật Real - Time PCR

Nguyen Dac Trung Tap chi KHOA HOC & CONG NGHE 131(01): 127- 130

XAC DINH DOT BIEN KHANG LAMIVUDINE CUA VIRUS VIEM GAN B

BANG KY THUAT REAL-TIME PCR

Nguyin Die Trung

Trudng Dgi hoc Y Duac - DH Thai Nguyen

TOM TA T

Lamivudine Id mot thuoc khdng virus dugc sir dung dieu tri viem gan virus B. Tuy nhien, tinh

trang khdng thuoc d virus dang trd thanh van de dugc quan tam trong thyc hanh dieu trj viem gan

virus B. Sy de khang lamivudine xuat hien do nhung thay doi trong gen reverse transcriptase ciia

virus viem gan B (HBV). Phat hien virus khang thulc se giiip kilm sodt hieu qua benh viem gan

virus B. Muc tiiu nghien cieu: Xdc dinh dugc mgt so dot bien diem khang lamivudine d HBV.

Phuang phdp nghien cieu: Sir dung ky thuat real-time PCR phat hien cdc dot bien khang

lamivudine. Kit qud nghien cieu: Mau huyet thanh ciia 162 benh nhan viem gan virus B man tinh

(chua dieu trj thu6c khang virus) da dugc sir dung dl phat hien mgt s6 dot biln khdng lamivudine.

Ket qua cho thay ty le dot biln khdng lamivudine ciia virus viem gan B la 22,83%. Ba vj tri dot

bi6n khdng lamivudine tren gen reverse transcriptase cua virus da dugc phat hien la rtl80, rtl204

va rtV204; vj Ui dot biln chilm uu thi Id rtI80 (16,04%) vd rtV204 (14,81%). Nam kilu ph6i hop

dgt biln lamivudine cung dd duoc xdc dinh Id rtl80, rtI204, rtV204, rtl80+rtl204 va

rtl80+rtV204 Kilu dot biln rt]80+rtV204 la ph6 biln (40,54%).

Tii- kh6a: Virus viem gan B (HBV), lamivudine, dot bien khdng thudc, real-time PCR.

DAT VAN DE

Theo thong ke ciia Td chirc Y te the gidi, cd

khoang ban 2 ty ngudi bi nhiem virus viem

gan B (HBV), trong dd cd 350 trieu ngudi

mang virus vien gan B man tinh [3]. Nhung

ngudi mang virus viem gan B man tinh la

ngudn lay nhiem quan trgng trong cdng ddng

va cd nguy ca tien trien thanh cac benh gan

nguy hiem nhu viem gan hoai tu

(necroinflammatory) cip hoac man tinh, xa

gan va dac biet la ung thu bieu md te bao gan

(hepatocellular carcinoma) [8]. Cd hai nhdm

thudc khang virus chu ylu diing dieu tn viem

gan virus B man tinh: nhdm thudc dieu hda

mien djch (interferon alpha) va nhdm

nucleotide/nucleoside analogues (lamivudine,

adefovir, telbivudine, entecavir va tenofovir).

Mgt vin dl dugc nhieu nghien ciru de cap tdi

la nguy ca xuat hien cac dgt bien khang

nucleoside analogues d virus viem gan B khi

dilu tri dot keo dai, trong do cac dot biln

khang lamivudine chiem ty le cao. Loai dot

bien chinh dl khang lamivudine la rtl08 va

rt204, nhiing kieu dot bien nay cd the xuat

Tel: 0978 626649. Email: dactrung69@gmait com

hien rieng le hoac ciing xuat hien d cac chimg

HBV [I], [4]. Tai Viet Nam, thilu hut thdng

tin ve khang thudc cua HBV da dan den hieu

qua thap trong dieu tn viem gan B man tinh,

ddng thdi lam gia tang nguy ca xuat hien cac

dot bien khang thudc d HBV, dan den dieu tn

that bai va benh gan tiep tuc tien trien. Muc

tieu cua nghien ciru: xac dinh cac dot bien

khang lamivudine tren gen reverse

transcriptase ciia HBV d mdt sd benh nhan

viem gan virus B man tinh chua dieu tri thudc

khang virus tai khu vuc tinh Thai Nguyen.

VAT LIEU, PHUONG PHAP NGHIEN CUXJ

Mau chirng am (HBV hoang dai): La mau

khdng chiia cac dot biln khang lamivudine

tai cac vi tri rtl 80, rt204 dugc xac djnh bang

giai trinh ty.

Mau huyet thanh: Benh nhan viem gan B

man tinh (HBsAg(+) keo dai tren 6 thang), cd

chi djnh dieu trj bang thudc khang virus

(HBV-DNA > 10' copies/ml, enzym ALT

tang) dugc lay mau huyet thanh phat hien

HBV-DNA va xac djnh dot bien khang

lamivudine (vj tri rtl 80, rt204 tren gen

reverse transcriptase).

127