我国部分地区静脉吸毒人群HCV基因型分布的探讨

Distribution of hepatitis C virus genotypes among intravenous drug users in parts of China

目的了解静脉吸毒人群丙型肝炎病毒(HCV)感染者的基因亚型分布及影响因素,为防治静脉吸毒人群感染HCV提供依据。方法收集828份静脉吸毒人群样本,HCV抗体初筛用酶联免疫吸附试验(ELISA),有反应性的样本再用重组免疫印迹法(RIBA)进行补充试验,阳性的样本进行核酸检测;核酸阳性的样本先用HCV基因分型试剂盒进行分型,未通过分型试剂盒确定型别的样本,再用巢式聚合酶链式反应扩增HCV CORE区进行测序,以确定HCV基因型。结果 828份静脉吸毒人群样本中,HCV抗体阳性498份,核酸检测呈阳性反应的样本390份,通过HCV基因分型试剂盒确定型别的样本311份,经CORE区测序确定型别的样本70份,有9份未成功扩增出序列,共有381份样本确定了基因亚型。其主要基因亚型为3b、3a、1b、6n及6a五种型别,分别占38.6%(147/381)、20.5%(78/381)、18.6%(71/381)、10.8%(41/381)、8.7%(33/381);不同地区之间流行的HCV基因型别差异具有统计学意义(χ~2=282.23,P<0.01);男性和女性之间主要基因型不太一致;各年龄段间HCV基因亚型分布的差异无统计学意义(χ~2=40.93,P>0.05),但30~50岁感染者居多。不同基因型之间HCV核糖核酸含量的差异有统计学意义(F=5.85,P<0.01)。结论静脉吸毒人群HCV感染者的基因亚型主要为1b、3a、3b、6a及6n,基因型分布具有地域性差异,并且病毒载量与基因型的分布具有相关关系。

Objective To investigate the distribution of hepatitis C virus（HCV）genotypes among intravenous drug users and the association with various risk factors among HCV patients.Methods 828 samples of intravenous drug users were collected for HCV antibody screening test and supplemental test.HCV antibody positive samples received nucleic acid test.The nucleic acid positive samples first got HCV genotyping by using diagnostic kit,and then nested PCR was used for the indeterminate genotyping samples to amplify HCV core region and determine HCV genotype.Results 498 out of 828 samples of intravenous drug users in HCV antibody were positive;390samples were positive in nucleic acid testing;and 311 samples got determined genotype by diagnostic kit for HCV genotyping.Successful sequencing was done with 70 samples for further genotyping analysis with core region,sequence of 9samples was unsuccessfully amplified.Distribution of HCV genotypes in different areas was statistically significant（P〈0.05）;distribution in two genders（male and female）was statistically significant（χ^2=14.5066,P=0.024 5〈0.05）.HCV RNA load difference among genotypes was statistically significant（F=5.85,P〈0.01）.Conclusion The study shows that HCV genotypes in intravenous drug users are mainly 3,6and 1b.Genotype distribution is regionally different,with some relation to gender and viral load.