乙型肝炎病毒核心基因启动子变异与患者血清病毒载量和标志物及肝功能的关系

Relationship among Hepatitis B Virus Basic Core Promoter Mutation and Serum HBV DNA Contents and HBV Markers as well as Liver Function

目的探讨乙型肝炎病毒核心基因启动子(HBV BCP)变异与患者血清病毒载量(HBV DNA)和标志物及肝功能的关系。方法采用PCR微板核酸杂交结合ELISA检测显示技术,对176例HBV慢性感染者血清进行检测BCP区核苷酸(nt)1762A→T和1764G→A联合突变。结果BCP变异在HBeAg阴性病例的阳性率为49.4%,显著高于HBeAg阳性病例的阳性率33.3%(P<0.05);BCP变异阳性组的HBV DNA含量显著高于阴性组的含量(P<0.01);BCP变异阳性组HBV DNA含量在HBeAg阳性病例及HBeAg阴性病例中均较BCP变异阴性组高(P<0.01);BCP变异阳性组对肝功能的损害明显高于阴性组(P<0.01)。结论BCP变异可引起HBeAg阴转,病毒复制水平提高;HBV血清标志物联合HBV DNA同步检测,具有重要的临床应用价值;对HBsAg阳性、HBeAg阴性患者需要进一步检测HBV DNA,以免由于基因变异导致将HBeAg阴性者误认为病毒的免疫清除或静息而延误抗病毒治疗时机;BCP变异可使病情加重。

OBJECTIVE To investigate the relationship among hepatitis B virus（HBV） basic core promoter（BCP） mutation,serum HBV DNA contents and HBV markers as well as liver function of chronic hepatitis B patients.METHODS The A to T mutation at nucleotide 1762 and G to A mutation at nucleotide 1764 were determined by the method of polymerase chain reaction（PCR） microplate hybridization ELISA in 176 patients with chronic hepatitis B virus infection.RESULTS The rate of HBV BCP mutants in negative and positive groups of HBeAg was 49.4% and 33.3%,respectively（P〈0.05）.The quantity of HBV DNA in HBV BCP mutant group was significantly higher than that in non-mutant group（P〈0.01）.The quantity of HBV DNA was significantly higher in HBV BCP mutant group than non-mutant group either in patients!with HBeAg＋（P〈0.01） or HBeAg-（P〈0.01）.Patients of HBV BCP positive group suffered from a more severe liver lesion than those of HBV BCP negative group did（P〈0.01）.CONCLUSIONS The T1762A1764G mutants in HBV BCP region could lead to the negative of HBeAg and the replication of HBV DNA.The detection of HBV markers and HBV DNA has its important clinical meaning.In HBV infected patients with HBsAg＋/HBeAg-,which are often conceived to have virus immune clearance or rest of virus replication,HBV DNA content should be tested to avoid missing the occasion of antiviral therapy.HBV BCP mutation could lead to the patients became more serious.