丙型肝炎病人基因分型与疾病严重程度及免疫活性细胞表达的关系

Study on the relationships between the genotyping and disease severity,expression of immunocompetent cells in patients with hepatitis C

目的:检测丙型肝炎(CHC)病人丙型肝炎病毒(HCV)基因型与疾病严重程度及免疫活性细胞表达的关系。方法:选取2017年6月至2018年7月169例青海地区藏族CHC病人为研究对象(CHC组),同期选取170名青海地区藏族健康体检者作为对照组。PCR-荧光探针检测HCV-RNA水平,PCR-反向杂交法进行HCV-病毒基因分型检测,酶联免疫吸附(ELISA)法血清中干扰素-γ(INF-γ)、白细胞介素-4(IL-4)水平,基因型分布与疾病严重程度,血清中INF-γ、IL-4关系;疾病严重程度与INF-γ、IL-4关系分析。结果:与对照组比较,CHC组HCV-RNA阳性率、血清中IL-4水平升高,INF-γ水平降低(P<0.01)。与慢性肝炎轻、中度组比较,慢性肝炎重度组、急性肝炎组HCV-RNA阳性率升高(P<0.05)。不同基因型、亚型分布的病人在CHC不同严重程度分组中HCV-RNA阳性率差异有统计学意义(P<0.01)。与HCV基因型1a比较,基因型2a、3b病人血清中INF-γ水平升高(P<0.01);与HCV基因型1b比较,基因型2a血清中INF-γ水平升高(P<0.01),IL-4水平降低(P<0.01);与HCV基因型2a比较,基因型3b血清中INF-γ水平降低(P<0.01)。CHC不同严重程度INF-γ、IL-4水平差异有统计学意义(P<0.01)。INF-γ水平,慢性肝炎轻度组和中度组、中度组和重度组,差异均无统计学意义(P>0.01),轻度组>重度组、中度组>重度组>急性组,差异均有统计学意义(P<0.01);IL-4水平,轻度组<中度组<重度组<急性组,差异均有统计学意义(P<0.01)。结论:青海地区藏族丙型肝炎病人检测到HCV(1a、1b、2a、3b)4种亚型,其中1b、2a比例较高,1b与疾病严重程度关系密切,1b型INF-γ水平降低、IL-4水平升高。

Objective:To detect the relationships between the genotype of hepatitis C virus(HCV)and severity of the disease,expression of immunocompetent cells in patients with chronic hepatitis C(CHC).Methods:From June 2017 to July 2018,169 Tibetan CHC patients were selected as the study objects(CHC group),and 170 Tibetan healthly examinees in Qinghai were selected as the control group.The levels of HCV-RNA in all cases were detected using PCR fluorescence probe,the PCR reverse hybridization was used to detect the HCV genotyping,and the levels of serum interferon-γ(INF-γ)and interleukin-4(IL-4)were measured by enzyme-linked immunosorbent assay(ELISA).The relationships between the genotype distribution,and disease severity,serum levels of INF-γand IL-4;and between disease severity,and levels of INF-γand IL-4 were analyzed.Results:Compared with the control group,the positive rate of HCV-RNA and serum level of IL-4 increased,and the serum level of INF-γdecreased in CHC group(P<0.01).The positive rates of HCV-RNA in severe chronic hepatitis group and acute hepatitis group were higher than that in mild and moderate chronic hepatitis group(P<0.05).The differences of the positive rates of HCV-RNA among different genotypes and different severity of CHC were statistically significant(P<0.01).Compared with the HCV genotype 1a,the serum levels of INF-γin patients with genotype 2a and 3b increased(P<0.01).Compared with the HCV genotype 1b,the serum level of INF-γincreased(P<0.01),and the serum level of IL-4 level decreased in genotype 2a(P<0.01).The serum level of INF-γin genotype 3b decreased compared with the genotype 2a(P<0.05).The differences of the serum levels of INF-γand IL-4 among different severity of CHC were statistically significant(P<0.01).There was no statistical significance in the levels of INF-γbetween mild and moderate group,and between moderate and severe group(P>0.05).The serum level of INF-γin the mild group was higher than that in severe group,it decreased gradually in moderate group,severe group and acute group,and the differences of which were statistically significant(P<0.01).The serum level of IL-4 increased gradually in the mild group,moderate group,severe group and acute group,and the differences of which were statistically significant(P<0.01).Conclusions:Four subtypes of HCV(1a,1b,2a and 3b)are detected in Tibetan patients with hepatitis C in Qinghai area,the proportions of 1b and 2a are high.The genotype 1b is closely related to the severity of the disease,the level of INF-γdecreases,and the level of IL-4 increases.