HBeAg阴性慢型乙型肝炎的临床分析及其与基因变异的关系

Clinical Characteristic of HBeAg-Negative Chronical Hepatitis-B and its Relationship with Virus Mutation

目的探讨HBeAg阴性慢性乙型肝炎(以下简称e-CHB)的临床特点及与前C区G1896A变异及基本核心启动子(BCP)区A1762T/G1764A双变异的关系。方法采用实时荧光定量PCR法检测HBVDNA,采用时间分辨荧光免疫分析法定量检测乙型肝炎病毒标志物,采用基因芯片检测基因变异。结果e-CHB患者其年龄、肝硬化及肝癌发生明显高于HBeAg阳性慢性乙型肝炎(以下简称e+CHB)患者(P<0·05);e-CHB患者在HBVDNA定量,慢性轻度肝炎比例明显低于e+CHB患者(P<0·05)。前C区G1896A变异及BCP区A1762T/G1764A双变异的总的变异率,e-CHB患者明显高于e+CHB患者(χ2=6·66,P<0·01)。结论e-CHB患者年龄较大,肝硬化、肝癌发生率高,在慢性乙型肝炎自然史中处于较晚阶段。e-CHB病毒复制减少。e-CHB主要是基因变异的结果;血清不同e系统均可发生变异。

Objective To probe into the clinical characteristic of the HBeAg-negative chronical hepatitis-B（e^- CHB for short）and its relationships with the G1896A mutation in the precore and with the A1762T/G1764A twin-mutation in the basal core promoter（ BCP for short）. Methods HBV DNA is examined with the real-time fluorescent quantitative PCR,HBVM examined with time-resolution immunofluorescence,the gene mutation tested with gene chips. Results In e^- CHB cases,there is older age, and higher proportion in liver cirrhesis and liver cancer than there is in HBeAg-positive chronical hepatitis-B （ e^＋ CHB for short） （ P 〈 0. 05 ） does. The quantity of HBV DNA and the proportion of light chronical hepatitis in e ^- CHB cases is smaller than that in e^ ＋ CHB cases （ P 〈 0.05 ）. There is a higher proportion in e^ - CHB cases in the G1896A mutation in the precore and the A1762T/G1764A twin-mutation in BCP core than in e ^＋ CHB cases （ x^2 = 6. 66 ,P 〈 0. 01 ）. Conclusion e^- CHB cases are mostly older aged,with higher probability of liver cirrhosis,or liver cancer,especially in the late period of the chronical hepatitis development. The virus reproduction of e^＋ CHB becomes reduced, e^ - CHB results mainly from gene mutation which can also occur in pesitive HBeAg in serum.