HBsAg携带者与HBeAg阴性慢性乙型肝炎患者病毒学特征的比较

Comparisons of virological characteristics between inactive HBsAg carriers and HBeAg negative chronic hepatitis B patients

目的了解非活动性HBsAg携带者(Inactive HBsAg carrier,HBsAg-IaC)和HBeAg阴性慢性乙型肝炎患者(e--CHB)病毒学特点的异同。方法对连续收集的HBsAg-IaC(n=187)和e--CHB(n=99)采用直接序列测定法检测G1896和核心基因启动子突变;结合聚合酶链反应-限制性片段长度多态性方法判断HBV基因型。结果113例HBsAg-IaC者血清HBVDNA阳性,其中103份完成前C区测序。HBsAg-IaC群体中HBV基因B型比例高于e--CHB患者(84/113对46/99,P<0.001);HBsAg-IaC的G1896A突变比例高于e--CHB(69/103对39/99,P<0.001),但A1762/G1764突变株比例低于后者(38/103对65/99,P<0.001)。男性(OR=7.681,95%CI=2.693～20.992,P<0.001)、年龄超过40岁(OR=24.421,95%CI=5.187～114.969,P<0.001)、基因C型感染(OR=2.695,95%CI=1.240～5.859,P=0.012)以及A1762/G1764突变(OR=2.116,95%CI=1.012～4.425,P=0.046)是与e--CHB相关的危险因素。结论HBsAg-IaC在病毒学特征上与e--CHB明显不同;HBV基因C型感染、发生A1762/G1764突变、年龄大的男性HBsAg-IaC群体可能需要更多关注。

Objective To compare the possible differences of virological characteristics between inactive HBsAg carriers（HBsAg-IaC）and HBeAg negative chronic hepatitis B patients（e^--CHB）. Methods The sera from HBsAg-IaC（n= 187）and e^--CHB （n=99）were consecutively collected and studied. Mutations at nt1896 and nt1762/1764 were analyzed by direct sequencing （nt1600-1974）,and HBV genotypes were determined with direct sequencing in combination with polymerase chain reaction-restriction fragment length polymorphism assay. Serum HBsAg quantification was performed on Abbott I2000 with Architect HBsAg assay. Results Serum HBsAg levels were not significantly different between these two groups（P=0.432）. 113 HBsAg-IaC had low level viraemia detected by nested-PCR and the HBV genotypes were then determined,and direct sequencing was successfully performed in 103 cases out of them. The prevalences of HBV genotype B（HBV/B）infection（69/103vs. 39/99,P〈0.001）and G1896A mutation（69/103vs. 39/99,P〈0.001）were higher in HBsAg-IaC than in e^--CHB, however,the prevalence of A1762T/G1764A mutations was lower in former group than in the latter（38/ 103vs. 65/99,P〈0.001）. Male （OR=7.681,95%CI=2.693-20.992,P〈0.001）,older than 40-year （OR=24.421,95%CI=5.187- 114.969,P〈0.001 ）, HBV genotype C （HBV/C）infection（OR=2.695,95%CI=1.240-5.859,P=0.012）and occurrence of A1762T/ G1764A mutations （OR=2.116,95%CI=1.012-4.425,P=0.046）were associated with e^--CHB. Conclusions Virological characteristics,including HBV genotypes,occurrences of mutations at G1896A and A1762T/G1764A were different between HBsAgIlaC and e^-CHB. And the male and older than 40-year HBsAg-IaC with HBV/C infection and /or A1762T/G1764A mutations should regularly followed-up.