舟山群岛慢性乙型肝炎病毒感染者基因型与临床病理的关系  

The relationship between the genotype of hepatitis B virus and clinical and liver pathological features of infected patients in the Zhoushan Islands, China

作　　者：李世波[1] 林志益[1] 丁贤君[1] 李翊卫[1] 李绍佐[1] 李春生[1] 顾若薇[1] 郭伟丽[1] 智日增[1] 杜文杰[1] 

机构地区：[1]舟山市人民医院感染性疾病科,浙江316000

出　　处：《中华肝脏病杂志》2007年第3期179-183,共5页Chinese Journal of Hepatology

基　　金：浙江省卫生厅医药卫生科学研究基金资助项目（2005A103）

摘　　要：目的观察中国舟山群岛慢性HBV感染者的基因型与临床病理变化的关系。方法180例两代以上生活在舟山群岛的当地居民，血清HBV标志物和HBVDNA均阳性的各类慢性肝病患者，男147例，女33例，年龄（39．0±11．3）岁，HBV携带者（ASC）17例，CHB轻度57例，中度48例，重度9例，重型肝炎（SHB）6例，肝炎后肝硬化（LC）39例，HCC4例。采用PeR结合TaqmanMGB探针技术，对血清中HBV基因型进行分型检测，同时检测HBV血清标志物、HBVDNA、肝功能。对其中的129例患者做肝组织活检。结果舟山群岛慢性HBV感染者HBV基因型C型135例，占75．0％，B型40例，占22．20／0，B、C混合型5例，占2.8％，未见有A、D型。随着病情加重，C型所占比例逐渐增高，在ASC、CHB，LC和SHB中C型分别占41．2％（7／17例），75．4％（86／114例）、87．20／0（34／39例），100％（6／6例）；在HCC中，B，C基因型各占2例。肝组织病理学检查中，99例C基因型患者，中，重度炎症（G3-4）有84例，占84．8％，30例B基因型患者G3～4有7例，占23．3％，Z=6．47，P〈0．01。C基因型在中，重度纤维化（S3～4）的分布与B基因型比较，差异有统计学意义。在中，重度肝脏病理损伤中C型病理改变与临床诊断符合率较好；而在轻度肝脏病理损伤中，B型病理改变与临床诊断符合率较好，C型符合率较差。结论中国舟山群岛HBV基因型为C、B及BC混合型，以C基因型占优势，C基因型的病理损伤程度较B型严重。Objective To investigate the relationship between the genotypes of hepatitis B virus and the clinical and liver pathological features of patients with chronic hepatitis in the Zhoushan Islands. Method One hundred eighty HBV DNA positive chronic hepatitis patients with HBV markers were enrolled in this study. They were at least second generation Zhoushan Island residents. One hundred forty-seven of them were males and 33 were females with an average age of 39.0 ± 11.3. Among the 180 patients, 17 had ASC, 57 had mild CHB, 48 moderate CHB, 9 severe CHB, 6 SHB, 39 LC, and 4 had HCC. The genotypes of their serum HBV were detected by using PCR integrated with Tagman MGB probe technology, and their serum HBV markers, HBV DNA and liver functions were also examined. Out of 180 patients, 129 accepted a liver biopsy. A pathological evaluation was then performed. Results HBVs of genotype C, 135 cases （75.0%）, of B, 40 cases （22.2%）, and of B＋C, 5 cases （2.8%） were found among these 180 patients. No genotype A or D HBV were found. The proportions of genotype C virus were 7/17, 86/114, 34/39, 6/6 in ASC, CHB, LC and SHB patients. In the hepatocellular carcinoma patients, there were 2 each of genotype B and C. Among the 99 patients with genotype C HBV, 84 cases （84.8%） showed moderate and severe inflammation histologically in their livers and among the 30 patients with B, 7 cases （23.3%） showed moderate to severe inflammation in their livers （z = 6.47, P 〈 0.01）. The proportion of genotype C HBV was significantly different from that of genotype B HBV in those that showed moderate and severe （S3-4） liver fibrosis. In patients infected with genotype C HBV who had moderate and severe liver pathological changes, their clinical manifestations reflected better the histological alterations of their livers. Conclusion Genotypes C, B and B＋C HBV were found in CHB patients in the Zhoushan Islands of China, and type C was the predominant one. The liver pathological damage level of genotype C HBV infected

关 键 词：肝炎病毒 乙型 基因型 病理学 临床 

分 类 号：R686[医药卫生—骨科学]