儿童乙型肝炎176例病毒基因型及乙型肝炎病毒相关性肾炎23例相关性分析

Relationship between B/C genotype of hepatitis B virus and hepatitis B virus related-nephritis inchildren

目的探讨乙型肝炎病毒（HBV）基因型与儿童HBV相关性肾炎（HBV．GN）的关系。方法研究对象为HBV-DNA阳性乙型肝炎患儿176例，均进行基因分型、同时检测肝肾功、HBV-DNA载量。对发生HBV-GN的23例患儿进行。肾脏穿刺活检。结果176例乙型肝炎患儿中，C基因型患儿85例（48．3％），B基因型72例（40．9％），合计157例纳入研究。研究显示，HBeAg阳性患儿发生HBV-GN的比率（78．3％）要显著高于HBeAg阴性组（21．7％）（X^2=18．301，P值〈0．001）。C基因型患儿发生血尿、蛋白尿的比率（20．0％，18．8％）显著高于B基因型患儿（8．3％，5．6％）（X^2=4．243，P=0．039；X^2=6．173，P=0．013），且丙氨酸氨基转移酶和补体C3的异常发生率在C基因型组（10．2％，15．3％）亦显著高于B基因型组患儿（2．8％，2．8％）（X^2=7．985，P=0．005；）（2=7．067，P=0．008）。HBV-DNA高载量患儿中C基因型患儿比例（79．2％）显著高于B基因型患儿（20．8％）（X^2=35．514，P=0．000）。结论甘肃地区儿童HBV基因型以C、B基因型为主，以C基因型为优势。C基因型患儿更易发生血尿、蛋白尿等肾脏损害表现。HBV．DNA的高载量可能与HBV-GN的发生有关。C基因型患儿DNA高载量发生几率显著升高可能是其更易发生HBV-GN的因素之一。

Objective To investigate the relationship between genotype of hepatitis B virus and hepatitis B virus related-glomerular nephritis in （HBV-GN） children. Method Totally 176 HBV-DNA positive children with chronic hepatitis B were randomly collected. Among the 176 patients, 92 were HBV carriers, 84 were cases with chronic hepatitis. The genotypes of their serum HBV, liver function, and HBV- DNA load were detected. When children showed nephrotic syndrome, renal biopsy was performed. Result Of the serum samples of 176 cases, 85 （48.3%） were genotype C, 72 （40. 9% ） were genotype B, 13 （7.4%） were genotype B/C, and 6 （3.4%） were non-B/C genotype which were excluded. Among the analyzed 157 cases, the ratio of HBV-GN in the HBeAg positive group （78.3%） was significantly higher than that in the negative group （21.7%） （ X^2 = 18. 301 ,P 〈 0. 001 ）. And, the ratio of HBV-GN in the genotype C group （ 73.9% ） was significantly higher than that in the genotype B group （ 26. 1% ） （ P 〈 0. 039）. The ratio of hematuria or proteinuria in the genotype C group （20% , 18.8% ） was significantly higher than that in the genotype B group（8.3%, 5.6%） （P〈0.039; P value = 0.013）; and the alteration of ALT or C3 in the genotype C group （ 10. 2% , 15.3% ） was more frequent than those in the genotype B group （ 2. 8% , 2. 8% ） （ P= 0. 005 ; P = 0. 008 ）. There were no significant differences in kidney dysfunction or hepatomegaly. Further, the ratio of HBV-GN was more significantly frequent in HBV- DNA highly loading group （79.2%） than which in HBV-DNA lowly loading group （20. 8% ） （P = 0. 000）. Finally, in HBV-GN group, genotype C cases （88.2%） more frequently had high HBV-DNA load condition than genotype B cases （11.8%） （P=0. 021 ）. Conclusion Children with HBV infection in Gansu province showed mainly genotypes C or B, while genotype C seemingly predominant. Patients with genotype C more frequently showed proteinuria or hematuria. The high HBV-DNA load may be related with HBV-GN. It isa potential reason in the mechanism of HBV-GN that patients with genotype C had more possibility to have HBV-DNA high load. Analysis of HBV genotype for HBV patients maybe helpful in diagnosis and treatment.