四川省德阳地区散发性戊型肝炎临床特点及病毒基因型

Distribution and Clinical Characteristics of Hepatitis E Virus Genotypes in Sichuan Deyang District

目的：了解四川省德阳地区戊型病毒性肝炎病毒基因型的分布情况及其临床特点。方法对154例急性戊型病毒性肝炎患者的血清生化学、抗HEV-IgM及HEV-IgG进行检测,并将患者血清进行RNA抽提和PCR扩增。对PCR扩增阳性的病例进行双向测序,应用Clustal X和MEGA软件对参考病毒株和样本病毒株的核苷酸序列进行比对并进行基因分型。结果154例急性戊型肝炎患者中,男111例（72.1%）,女43例（27.9%）,男/女为2.58/1,平均年龄为（45.6±16.3）岁,20~59岁年龄段的患者的例数占总体的77.9%。92例住院患者中有49例为单纯戊型肝炎患者,其中2例（4.1%）发生急性肝衰竭并死亡；有42例戊型肝炎合并慢性HBV感染患者,其中11例（26.2%）患者发展为慢加急性肝衰竭,10例（23.8%）患者死亡,二者间肝衰竭的发生率及病死率的差异有统计学意义（P〈0.05）。154例戊型肝炎患者的血清标本中检测出HEV RNA（＋）34例（22.1%）,其核苷酸序列间同源性为76.6%~98%。所检测的病毒株与基因Ⅳ型参考病毒株的同源性最高（76.6%~95.9%）。序列比对及基因分型结果表明该34例患者所感染的戊型肝炎病毒均为基因Ⅳ型。结论戊型肝炎合并慢性 HBV感染者较单纯戊型肝炎患者更易重症化,本地区 HEV基因型以Ⅳ型为主。

Objective To investigate the distribution and clinical features of Hepatitis E Virus genotypes in Deyang dis-trict,Sichuan Province. Methods Serum samples from 154 acute HEV patients were tested by biochemical methods and ELISA. Total RNA were extracted from serum samples and used for PCR amplification. PCR positive products were bi-directional se-quenced. Clustal X and MEGA 4. 1 were used for nucleotide alignment and phylogenetic analysis. Results Among these 154 a-cute HEV patients,111（72. 1%）were male and 43（27. 9%）were female. The average age of these patients was 45. 6 ± 16. 3 and 77. 9% of these patients aged from 20 to 59 years old. Among 92 hospitalized patients,49,42 and 1 was infected with HEV,HEV plus HBV and HEV plus HCV,respectively. Two patients infected with HEV developed into acute liver failure and both of them were dead. In patients co-infected with HEV and HBV,11 patients developed into acute liver failure and 10 of them were dead. The differences of occurrence rates of liver failure and fatality rates between patients infected with HEV and HEV plus HBV were