上海急慢性乙型肝炎患者病毒基因型分布概况比较

Comparison of genotype distribution of patients with acute hepatitis B infection or chronic hepatitis B infection in Shanghai

目的了解上海急慢性乙型肝炎患者的病毒基因型分布概况。方法2003至2007年入住上海长海医院的62例急性乙型肝炎（AHB）患者和随机抽取的73例同期住院的慢性乙型肝炎（CHB）患者被纳入本研究。对所有患者血清HBVS区基因应用直接基因测序方法进行基因分型，同时收集肝功能、病毒学指标和相关流行病学资料。对组间均数差异应用t检验，频率差异用矿检验。结果上海地区AHB和CHB的主要病毒基因型为B型、C型，分别为48．4％（30／62）、51．6％（32／62）和26．0％（19／73）、74．0％（54／73），B型在AHB比例明显高于CHB（P〈0.05）。在流行病学特征和临床转归方面，这两种病毒基因型在AHB之间差异无统计学意义。C型在CHB中比例明显高于AHB（χ^2=7．25，P〈0.01）。AHB组的主要传播途径为多伴侣性接触，为18例，占29．0％；CHB组的主要传播途径为母婴传播，为38例，占52．1％。结论上海地区AHB和CHB主要病毒基因型均为B型和C型，AHB组B型所占比例相对较高，CHB组C型所占比例相对较高，病毒基因型与AHB临床预后无关。

Objective To investigate the distribution of genotypes in chronic HBV infection （CHB） and acute HBV infection （AHB） patients in Shanghai. Methods Sixty-two patients with AHB and 73 patients with CHB admitted to Changhai Hospital of Shanghai between 2003 and 2007 were studied. Viral genotypes of all the patients were determined by direct gene sequencing. Meanwhile, epidemiological, clinical and biochemical parameters of all patients were collected. Mean values of different groups were compared by t test while frequency was compared by chi square test. Results The major prevalent genotypes in both AHB and CHB patients were genotype B and C （48.4% vs 51.6% in AHB patients and 26. 0% vs 74.0% in CHB patients）. The proportion of genotype B was higher in A HB patients compared to CHB patients （P = 0.02）. Epidemiologieal factors and clinical outcomes were not statistically different among patients with different viral genotypes. The proportion of genotype C was much higher in CHB patients compared to AHB patients （P= 0.006）. The main transmission route of AHB was heterosexual interaction which was 18 out of 62 （29.0%）, but in CHB patients, it was prenatal transmission which was 38 out of 73 （52.1%）. Conclusions In shanghai, the main HBV genotypes in both AHB and CHB patients are genotype B and C. The proportion of genotype B is relatively high in AHB patients while proportion of genotype C is more common in CHB patients. There is no significant relationship between genotypes and the clinical outcomes of AHB patients.