慢性乙型肝炎和肝硬化患者血清HBV基因型分析

Hepatitis B viralgenotypes in patients with chronic hepatitis B and cirrhosis

目的分析慢性乙型肝炎和肝硬化患者血清乙型肝炎病毒(HBV)分型分布情况。方法2015年6月~2018年5月南京中医药大学附属南京市第二医院就诊的慢性乙型肝炎患者261例,乙型肝炎肝硬化患者30例,肝细胞癌4例,采用测序法检测血清HBV基因型。结果在295例HBV感染者中,有132例(44.7%)为B型感染,161例(54.6%)为C型感染,2例(0.7%)为D型感染;慢性乙型肝炎患者与肝硬化患者血清TBIL、ALT和AST水平比较差异均无统计学意义(P>0.05);肝硬化患者血清肝纤维化指标(P<0.05)、血清HBV DNA载量(P<0.05)和血清HBeAg阳性率(χ^2=5.798,P<0.05)均显著高于慢性乙型肝炎患者;乙型肝炎肝硬化患者和肝细胞癌患者C型感染比例均显著高于慢性乙型肝炎患者,差异具有统计学意义(P<0.05)结论慢性乙型肝炎和肝硬化患者HBV感染以B基因型和C基因型为主,而肝硬化患者以C型感染居多,提示C型感染患者可能比B型患者更容易出现严重的肝损伤,并产生严重的临床结局。

Objective To investigate the distribution of hepatitis B viral genotype in patients with chronic hepatistis B(CHB)and liver cirrhosis(LC).Methods 261 patients with CHB,30 with LC and 4 with hepatocellular carcinoma(HCC)were recruited in this study,and HBV genotypes were determined by DNA sequencing.Results Among the 295 HBV infected patients,132(44.7%)were with genotype B infection,161(54.6%)were with genotype C infection,and 2(0.7%)were with genotype D infection;7 positive patterns of HBV serological markers were found in our series,and there were no significant differences with respect to serum bilirubin,ALT and AST between patients with CHB and patients with LC(P>0.05);the indexes of liver fibrosis(P<0.05),serum HBV DNA loads(P<0.05)and serum HBeAg positive rate(χ^2=5.798,P<0.05)in patients with cirrhosis were significantly higher than those with chronic hepatitis B;te proportions of genotype C in patients with LC and HCC were higher than that in patients with CHB(P<0.05).Conclusions The prevalence of HBV genotypes in patients with CHB and LC are predominantly genotype B and C,and the genotype C infections might lead to severe clinical outcomes.