HCVRNA载量在慢性丙肝、肝硬化、肝癌患者中的变化及基因分型

The hepatitis C virus( HCV) RNA load changes in chronic hepatitis C、HCV-related liver cirrhosis and HCV- related hepatocellular carcinoma groups and genotype effects on disease progression

目的了解丙型肝炎病毒RNA(HCVRNA)载量在慢性丙型肝炎、丙型肝炎肝硬化、丙肝相关的肝癌(HCV-HCC)患者中的变化及基因分型对疾病进展的影响。方法回顾性分析2010年2月至2013年8月门诊及住院的1 386例HCVRNA阳性且未进行抗病毒治疗的丙型肝炎患者的临床病例资料,把患者按诊断分为丙型肝炎组、丙肝肝硬化组、丙肝相关的肝癌组,采用qRT-PCR检测患者血清的HCVRNA载量与基因分型,多组比较采用方差分析或卡方检验,两组间比较采用t检验。结果丙型肝炎组、丙肝肝硬化组及丙肝相关的肝癌组患者HCVRNA载量分别为(6.47±1.03)lg IU/mL,(6.18±1.09)lg IU/mL和(6.07±1.13)lg IU/mL,三组患者HCVRNA载量不同,丙型肝炎组HCVRNA明显高于其他二种,且差别有统计学意义(F=12.80,P<0.05),但丙肝肝硬化组与HCV-HCC组患者HCVRNA载量差别无统计学意义(t=0.65,P>0.05)。1 386例患者中816例进行了HCV基因型检测,1型基因型529例(64.83%),2型基因型287例(35.17%),丙型肝炎组患者1型基因型者为400例,2型基因型者为226例,1b型基因型为主(63.10%),丙肝肝硬化组1型基因型117例,2型基因型为57例,1b型基因型为主(65.52%),HCV-HCC组1型基因型为12例,2型基因型为4例,1b型基因型为主(68.75%),三组患者基因型比例无明显差别(χ2=1.02,P=0.31)。结论 HCVRNA载量在慢性丙型肝炎发展为肝硬化、肝癌的过程中减低,河南地区丙肝患者以1型基因型为主,且1型、2型基因型对疾病的进展没有影响。

Objective To evaluate the hepatitis C virus（HCV） RNA load changes in chronic hepatitis C,HCV -related liver cirrhosis and HCV - related hepatocellular carcinoma groups and the genotype effects on disease progression. Methods Totally 1386 patients from inpatient and outpatient department of our hospital whose HCVRNA is positive and not receive antiviral therapy were retrospectively analyzed from Feb 2010 to Aug 2013, these patients were divided into three groups according to the diagnosis ： Chronic hepatitis C group, HCV - related liver cirrhosis group, HCV - relat- ed hepatoeellular carcinoma group. The HCVRNA load and genotype of the HCV were analyzed by quantitative real - time polymerase chain reaction（ qRT - PCR）. Multiple groups were compared using analysis of variance or chi - square test,the comparison between the two groups using the t test. Results The HCVRNA load of the chronic hepatitis C group, HCV - related liver cirrhosis group and HCV - related hepatocellular carcinoma group were （ 6. 47 ± 1.03 ） lg IU/ mL, （6. 18 ± 1.09 ） lg IU/mL and （6.07 ± 1.13 ） lg IU/mL, respectively, which demonstrated that the HCVRNA load in chronic hepatitis C group was much higher than that of the other two groups （F = 12. 80, P 〈 0. 05 ）. But no significant difference of HCVRNA load was found between HCV - related liver cirrhosis and HCV - related hepatocellular carcinoma group （ t = 0. 65,P 〉 0. 05 ） ; Of the 1386 included patients, 816 cases was analyzed for genotype. Type 1 genotype was 529 cases（64. 83% ） ,type 2 genotype was 287 cases（35.17% ） ,In the hepatitis C group,there was 400 patients with type 1 genotype and 226 cases with type 2 genotype which demonstrated type 1 b genotype dominated （63.10%）. In the hepatitis C cirrhosis group, there was 117 patients with type 1 genotype and 57 cases with type 2 genotype which demon- strated type l b genotype dominated（65.52% ）. In the HCV -related hepatocellular carcinoma group, there was 12 pa- tients with type lb genotype and 4 cases with type 2a genotype which demonstrated type lb genotype dominated （ 68.75 % ）. There was no statistical difference distribution of the genotype among the three groups （ X2 = 1.02, P = 0. 31 ） Conclusion The HCV RNA load in the procedure of patients with chronic hepatitis C developing cirrhosis and hepato- cellular carcinoma was decreased. The type 1 genotype of HCV was dominant in Henan Province,genotype 1 and 2 have no effect on the progression of the disease.