十堰地区乙肝病毒基因型分布及其临床意义

Distribution of hepatitis B virus genotype in Shiyan district and its clincal significance

目的：了解十堰地区乙肝病毒基因型分布情况以及基因型与临床特征的关系，探讨其临床意义。方法：采用型特异性引物巢式PCR方法对本地区244例乙型肝炎患者进行基因型检测，同时对部分PCR产物进行测序，确定其基因型。结果：在244例乙型肝炎患者中，B型165例（67．62％）、BC混合型74例（30．33％）、C型5例（2．05％）．未发现A、D、E、F型；AsC中，B型36例，占76．60％；HF、AHB、HCC中B基因型占绝对优势，分别为95．96％、100％、81．82％，显著高于LC的57．69％和CHB的60．00％，其中HF与LC、CHB之间差异显著（P〈0．05，P〈0．01）；CHB中BC混合型51例（37．38％），与AsC中10例（21．28％）比较有统计学意义（P〈0．05）；B基因型患者血清AIJ（323．57±596．83IU／L）、AST（254．88±460．94IU／L）、TBil（100．67±137．09μmol／L）均高于BC混合型（160．70±235．62IU／L、137．57±201．95IU／L、50．97±78．93μmol／L），差异有显著性意义（P〈0．05）；基因型分布在年龄、性别及HBeAg阳性率上均无差异；B基因型HBVDNA水平处于高度复制状态（〉10^8copies／m1）的比例占49．12％（56／114），比BC混合型32．14％（18／56）高，BC混合型中中度复制（10^5-10^8copies／ml）和低度复制（〈10^5copies／ml）占67．86％（38／56），比B型50．88％（58／114）高（P〈0．05）。结论：本地区基因型以B型为主，BC混合型次之，C型少见；B型在AsC、HF、AHB、HCC中占优势，与疾病的活动度及预后密切相关：BC混合型在CHB和LC中多见，与乙型肝炎慢性化相关。

Objective： To investigate the distribute of hepatitis B virus in Shiyan city of Hubei Province and the relationship between the genotype and clinical characters for exploring its clinical significance. Methods： Serum samples from 244 patients with hepatitis B virus （HBV） infection were collected and tested for HBV genotype by type-specific primers. Results： Of the 244 patients, 165 （67. 62% ） were genotype B and 74 （30. 33% ） were B, C combination, only 5 were genotype C; Among ASC, 36 patients （76.60%） were genotype B. The percent of genotype B in FHF, AHB, HCC （95.96%, 100%, 81.82% respectively） were significantly higher than that in LC （57.69%） and CHB （60.00%） ; The differences existed between FHF and LC as well as HCC （P 〈0. 05, P 〈0. 001 ） ; B, C combination was prevalent in CHB than of ASC patients （P 〈 0. 05 ） ; The values of AST, ALT, TBil were higher in genotype B than in B, C combination （P 〈 0. 05 ） ; The proportion of HBV DNA level in the state of high copy （ 〉 10^8 copies/ml） of patients with genotype B was higher than that with B, C combination, but in the state of mediate and low copy was lower. Conclusion ： In Shiyan city, genotype B is the major genotype and BC combination has high proportion; Genotype B is prevalent in FHF, AHB, HCC, and associated with the activity and result of the disease; BC combination is more common in CHB, LC, and related to the chronic progress of hepatitis B.