川南地区丙型肝炎病毒基因型的特征及其临床价值

Characteristic and Clinical Value of HCV Genotypes in Southern Sichuan Area

目的了解丙型肝炎病毒(hepatitis C viral,HCV)基因型在川南地区汉族丙型肝炎患者中的分布特点及其临床意义。方法采用焦磷酸测序法对109例来我院就诊的丙型肝炎患者进行HCV基因分型并探讨不同基因型在丙型肝炎致病性的差异。结果 1106例来自川南地区HCV-RNA阳性的丙肝患者成功分型,共发现4种基因型7种亚型,按照1a、1b、2a、2b、3a、3b、6a的顺序,所占的比例依次是:2.8%、49.1%、4.7%、2.8%、3.8%、25.5%、11.3%;急性丙型肝炎、慢性丙型肝炎和丙肝后肝硬化三种临床类型的丙型肝炎均以1b型为主,其次是3b、6a型;本测序方法敏感度达到97.2%,特异性为100%;21b型患者的肝功能损害指标、HCV载量均明显高于其它亚型患者,差异有统计学意义(P<0.05)。结论川南地区HCV-RNA阳性的汉族HCV感染者以1b为优势基因,3b、6a型占有较高比例;1b型HCV载量更高,可比其它亚型更容易造成丙型肝炎的慢性化、肝脏纤维化及肝功能的严重损害。

Objective To understand the distribution characteristics of hepatitis C virus（ HCV） genotypes among the Han patients with hepatitis C in southern Sichuan area and its clinical value.Methods Totally 109 cases of hepatitis C in our hospital were performed the HCV genotyping detection by pyrophosphate sequencing method,then the differences in pathogenicity of hepatitis C among the patients with different groups were investigated. Results ①In 109 cases of HCV-RNA positive hepatitis C in southern Sichuan area,106 cases were successfully genotyped,and 4 genotypes and 7 sub-genotypes were found. According to the 1a,1b,2a,2b,3a,3b,6a order,their proportions were 2. 8%,49. 1%,4. 7%,2. 8%,3. 8%,25. 5% and 11. 3% respectively; 1b was main subtype in acute hepatitis C,chronic hepatitis C and 1iver cirrhosis after hepatitis C,fo1 lowed by 3b and 6a.The test sensitivity was 97. 2% and specificity was 100. 0%; ②In the patients with hepatitis C,the 1b sub-genotypes has significantly higher liver function indexes and HCV-RNA load than other types,and the difference were statistically significant（ P〈0.05）. Conclusion HCV 1b is the most predominant subtype among hepatitis C Han nationality patients in southern Sichuan area,and 3b and 6a subtypes also occupy a very high proportion. HCV 1b has higher HCV-DNA load and is easier to cause chronic hepatitis C,liver fibrosis and severe liver damage than any other type