浙东地区丙型肝炎病毒基因分型及临床意义的研究

Genotyping and its clinical significance of hepatitis C virus in Eastern Zhejiang

目的分析浙东地区丙型肝炎病毒(HCV)基因型分布特点,并探讨其与性别、年龄、病毒载量、抗病毒疗效等的相关性。方法选择2011年1月至2018年4月在宁波市第二医院就诊的HCV感染患者501例,分别采用基因芯片法、RT-PCR法检测HCV基因型和HCV RNA,同时检测肝功能和血常规指标,计算APRI指数,对部分接受聚乙二醇化干扰素联合利巴韦林(PR)标准方案治疗的患者分析获得持续病毒学应答(SVR)的影响因素。结果501例患者中不同基因型的例数(百分比)由高到低依次为1b、6、2a、3a、3b、1a,其中1b型超过50%。不同年龄段患者HCV基因型的分布有显著差异(χ^2=95.433,P<0.001),1a、1b、2a型患者的年龄显著高于3a、3b、6型(F=11.879,P均<0.001)。不同性别患者HCV基因型的分布差异不大(χ^2=1.638,P=0.897)。不同基因型患者的病毒载量、AST、PLT和APRI指数均存在显著差异(F=2.920、χ^2=12.400、F=6.294、χ^2=12.700,Ρ均<0.013),而ALT的差异不大(χ^2=7.994,P>0.157)。对其中179例明确使用PR标准方案治疗的患者进行随访,结果显示不同基因型患者的疗效总体差异无统计学意义(χ^2=6.598,P=0.252),但3a型患者持续病毒学应答率显著高于1b型(χ^2=4.193,P=0.041)。结论浙东地区HCV感染以1b和6型为主,不同HCV基因型患者年龄、病毒载量、AST、PLT和APRI指数存在显著差异,其中3a型患者经PR方案治疗的效果优于1b型。

Objective To analyze the distribution of HCV genotype in eastern Zhejiang Province and its correlation with sex,age,viral load,antiviral effect and so on.Methods A total of 501 cases of HCV infection seen in Ningbo No.2 hospital from January 2011 to April 2018 were included.The HCV genotypes and HCV RNA were detected by gene chip method and RT-PCR respectively.The liver function and blood routine tests were performed and the APRI index was calculated.The factors affecting the SVR were analyzed for the patients who were partially treated with pegylated interferon and ribavirin(PR).Results The HCV genotypes of 501 cases were 1b、6、2a、3a、3b、1a from the higher to lower ranks,and genotype 1b was more than 50%.The distribution of HCV genotypes in different age groups was significantly different(χ^2=95.433,P<0.001).The age of patients with 1a,1b and 2 A was significantly higher than that of 3a,3b,and type 6(F=11.879,P<0.001).There were significant differences in viral load,AST,PLT and APRI index among different genotypes(F=2.920,χ^2=12.400,F=6.294,χ^2=12.700,all P<0.013),but ALT had little difference(χ^2=7.994,P>0.157);179 patients with PR standard regimen were followed up.The result showed that there was no significant difference in the overall efficacy of different genotypes(χ^2=6.598,P=0.252),but the rate of sustained virological response in type 3 A was significantly higher than that of the 1b type(χ^2=4.193,P=0.041).Conclusions The HCV genotypes are mainly 1b and 6 in eastern Zhejiang Province.There were significant differences in age,viral load,AST,PLT and APRI indices among patients with different HCV genotypes,and the therapeutic effect of PR regimen was better for genotype 1b than that of 3a.