慢性HBV基因型C型感染者临床特征分析

Clinical analysis of HBV-infected patients with genotype C

目的:在了解延安地区乙型肝炎病毒基因型分布特征的基础上,进一步探讨延安地区HBV基因型C型感染者的临床分型与病毒学和生化学指标的特征.方法:随机选取HBV DNA阳性慢性乙型肝炎患者122例(病史均超过12mo),在可检出基因型121例患者中,慢性无症状HBV携带者(ASC)58例,慢性乙型肝炎(CHB)46例,肝硬化(LC)17例,采用乙型肝炎病毒核酸扩增荧光定量检测HBV DNA载量;时间分辩荧光免疫分析(TRFIA)技术定量检测乙肝血清标志物,微板核酸杂交-ELISA法测定HBV基因型.结果:在121例可检出基因型的患者中,C型116例(95.87%,95%CI:92.32%-99.42%).C基因型感染者中:ASC组HBV DNA载量、HBeAg定量明显高于CHB组及LC组(t=3.94、4.75,P=0.000,0.000;t=4.82、3.94,P=0.000,0.001);ASC组HBeAb定量、ALT水平明显低于CHB组及LC组(t=3.71、12.09,P=0.000、0.000;t=12.44、7.81,P=0.000、0.000).CHB组与LC组HBV DNA载量、HBeAg定量、ALT水平明没有明显差异(P=0.38,0.58,0.047);ASC组、CHB组、LC组年龄之间比较差异明显(t=5.07、9.72、4.99,P=0.000、0.000、0.000),ASC组年龄最低;CHB组、LC组男性比例明显高于ASC组(χ2=9.37,5.18,P=0.002,0.023).结论:HBV基因型C型是延安地区慢性HBV感染者优势株;C型感染者ASC组、CHB组、LC组间分析结果基本符合慢性HBV感染者临床自然史转归特征.

AIM： To investigate the distribution of hepatitis B virus （HBV） genotypes in Yan＇an region of China, and to examine the relationship between the clinical types of the patients infected with HBV genotype C and the clinical virological and biochemical outcome of chronic HBV infection. METHODS： One hundred and twenty-two chronic HBV-infected patients with HBV DNA positive and a disease history of more than 12 months were randomly selected from Yan＇an region, and the genotypes were detected in 121 patients, consisting of 58 chronic asymptomatic HBV carriers （ASC）, 46 chronic hepatitis B （CHB） patients and 17 liver cirrhosis （LC） patients. Real time fluorescence quantitative polymerase chain reaction （FQ-PCR） and time-resolved fluoroimmunoassay （TRFIA） were used to measure their HBV DNA contents and HBV marker quantity, respectively. Micro-PCR and hybridization- ELISA were used to detect HBV genotypes. RESULTS： Of the 121 serum samples with detected genotypes, 116 were of genotype C （95.87%, 95%CI： 92.32%-99.42%）. In the genotype C group, the HBV DNA level and HBeAg quantity were markedly higher in the ASC group than in the CHB group or the LC group （t = 3.94, 4.75, P = 0.000, 0.000; t = 4.82, 3.94, P = 0.000, 0.001）. However, HBeAb quantity and ALT level were markedly lower in the ASC group than in the CHB or the LC group （t = 3.71, 12.09, P = 0.000, 0.000; t = 12.44, 7.81, P = 0.000, 0.000）. No significant differences in HBV DNA level, HBeAg quantity or ALT level were observed between the CHB group and the LC group （P = 0.38, 0.58, 0.047）; significant difference in age was observed among the ASC, CHB and LC groups （t = 5.07, 9.72, 4.99, P = 0.000, 0.000, 0.000） and the mean age in ASC group was the lowest ; the male percentage was significantly higher in ASC group than in CHB or in the LC group （χ^2 = 9.37, 5.18, P = 0.002, 0.023）. CONCLUSION： Genotype C is the most prevalent strain among chronic HBV-infected patients in Yan＇an region of China; the results of the index analysis to the patients of the ASC, the CHB and the LC group basically conform to the clinical outcome of natural course of chronic HBV infection