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目的：探讨乙型肝炎病毒（hepatitis B virus，HBV）序列rt238 位点的氨基酸多态性与抗病毒治疗、耐药突变及基因型等的关系。方法：采用P 区测序法对76 例阿德福韦（adefovir，ADV）基因耐药患者、52 例拉米夫定（Lamivudine，LAM）基因耐药患者和50 例未经抗病毒治疗的慢乙肝患者的血清病毒进行P区测序。结果：在76 例ADV基因耐药患者中，rt238 的三种不同类型氨基酸在HBV基因型中的分布差异显著（x2=40.196，P=0.000）。RtH238 主要出现在基因型B 患者中，rtN238 主要出现在基因型C 患者中，而rtT238的HBV 序列全部为基因型C。控制HBV基因型，rt238 氨基酸类型与rt181、rt236位点突变无明显相关。rtT238 只出现在ADV和LAM基因耐药组。Rt238 位点的氨基酸在不同治疗组中的分布无统计学意义(P=0.127)。结论:Rt238位点的氨基酸多态性与HBV 基因型显著相关，是一个基因型依赖位点，rtT238可能是基因型C 相关的潜在耐药突变。

英文摘要:

Objective:To investigate the relationship between amino acid polymorphism of rt238 site in HBV sequence and clinical or virological factors, mainly including antiviral therapy, resistant mutations and HBV genotype.Methods:P region of HBV gene in 76 patients with ADV genotypic resistance, 52 cases with LAM genotypic resistance and 50 chronic hepatitisB (CHB) patients without antiviral therapy were sequenced and analyzed.Results:Of 76 cases with ADV genotypic resistance, the three types of amino acid in rt238 position had significant difference in HBV genotypes（x2=40.196，P=0.000）. RtH238 mainly occurred in genotype B, rtN238 occurred more frequently in genotype C, and rtT238 was only found in genotypes C. With the control of HBV genotypes, the amino acid types of rt238 didn't correlated with rt181 and rt236 mutation. RtT238 only appeared in ADV or LAM genotypic resistant groups. The distribution of rt238 types had no significant difference in untreated group, LAM resistant group and ADV resistant group (P=0.127).Conclusion:Amino acid polymorphism of rt238 site in HBV gene had significant correlation with HBV genotype, and rtT238 may be a potential resistant mutation associated with genotype C.

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