乙型肝炎病毒基因型的分布及与临床相关性

Distribution of hepatitis B virus genotypes and its clinical significance

目的了解镇江地区乙型肝炎病毒(HBV)基因型的分布及与临床的相关性。方法选择镇江地区HBV感染者257例,其中慢性HBV携带者49例,慢性乙型肝炎轻度52例、中度38例、重度32例,重型肝炎22例,肝硬化41例,原发性肝癌23例。应用聚合酶链反应(PCR)微板核酸杂交-酶联免疫吸附(ELISA)技术检测HBV的基因型。结果257例HBV感染者中B基因型112例(43.6%),C基因型140例(54.5%),B+C基因型5例(1.95%),未发现A、D、E、F、G和H基因型。C基因型在慢性乙型肝炎重度、重型肝炎、肝硬化、肝细胞癌中占绝对优势,分别占65.6%、72.7%、68.3%、78.3%,显著高于慢性HBV携带者的38.8%,P<0.05。C基因型HBV感染者的血清丙氨酸氨基转移酶(ALT)水平(262.3±319.7u/L)、总胆红素(TBIL)水平(69.9±35.8μmol/l)、HBeAg阳性率(67.1%)、HBV DNA定量中位数绝对值(6.02±1.34)显著高于B基因型(141.5±206.1u/L)、(38.3±22.4μmol/l)、46.4%和4.18±1.10,P<0.05。B基因型HBV感染者的血清白蛋白(ALB)水平(39.6±9.6g/)显著高于C基因型(30.1±7.3g/l),P<0.05。结论PCR微板核酸杂交—ELISA技术可用于HBV基因型的临床检测。镇江地区HBV感染者基因型以单一的B型或C型为主,含少量B+C型。C基因型为本地区优势基因型,并在严重肝病和原发性肝癌中比例较高,其引起的ALT、TBIL、病毒血症水平均较高,HBeAg血症持续时间长,故预后较差。

Objective To investigate the distribution of hepatitis B virus genotype in Zhenjiang city and its clinical significance. Methods Serum sample from 257 patients with chronic HBV infection, including 49 asymptomatic HBV carriers（ASC）,52 mild chronic hepatitis B, 38 moderate chronic Hepatitis B, 32 severe chronic hepatitis B, 22 fulminant hepatitis failure（FHF）,41 liver cirrhosis（LC）,and 23 hepatocellular carcinoma（HCC） patients were collected and tested for HBV genotypes by polymerase chain reaction（PCR） micro-board nucleic acid hybridization-enzyme-linked-immunosorbent assay（ELISA）. Results Of the 257 patients with chronic HBV infection, 112（43. 6%） were genotype B and 140 （54.5%） were genotype C. Genotype C was more prevalent in the severe chronic hepatitis B, FHF, LC and HCC patients than in the ASC patients （P〈0.05）;the ALT, TBIL, the rate of HBeAg positive and the HBV DNA level were signifi cantly higher in genotype C than in genotype B patients （P〈0. 05） ;the ALB, the rate of anti-HBe were significantly higher in genotype B than in genotype C patients （ P〈0. 05）. Conclusion The system we used seems to be a useful tool for testing HBV genotypes. Genotype B,genotype C and genotype B＋C combination exist in Zhenjiang city,and genotype C is the major genotype in this area especially in FHF and HCC patients. It increase ALT,TBIL, the level of viremia and HBeAg lasts longer, so the prognosis is poor.