乙肝病毒基因型与肝脏病理改变的关系  

Relationship between the histology and genotype of hepatitis B virus DNA in chronic hepatitis B patients

作　　者：钟崇芳[1] 郝娃[1] 李卓[1] 孟欣[1] 严艳[1] 牛京勤[1] 殷继明[1] 

机构地区：[1]首都医科大学附属北京佑安医院北京市卫生局肝炎研究所,北京市100069

出　　处：《世界华人消化杂志》2007年第16期1859-1864,共6页World Chinese Journal of Digestology

基　　金：北京市科委重大基金项目;No.H020920020590~~

摘　　要：目的:探讨乙型肝炎病毒基因型与慢性乙型肝炎患者肝脏病理变化的关系.方法:应用乙肝病毒型特异性引物采用巢式聚合酶链反应(PCR)和荧光定量聚合酶链反应(FQ-PCR),对北京佑安医院住院92例慢性乙型肝炎患者进行乙型肝炎病毒基因型及亚型分析,参照2000年《病毒性肝炎防治方案》对慢性肝炎进行病理分级、分期诊断.结果:92例慢性乙型肝炎患者中HBV基因型分布为B型17例(B2亚型),B/C混合型17例(B2/Ca亚型),C型58例(Ca亚型).17例HBV B型感染患者中病理诊断肝脏炎症活动分级为G1-G3期分别为35.29%,58.82%,5.88%;肝脏纤维化程度分级为S1-3级分别为58.82%,29.41%,11.76%,17例HBV B/C型感染患者中病理诊断肝脏炎症活动分级为G1-G3期35.29%,52.94%,11.76%;肝脏纤维化程度分级为S1-3级23.52%,52.94%,23.52%,58例HBV C型感染患者中病理诊断肝脏炎症活动分级为G1-G4期31.03%,24.14%,36.21%,8.62%;肝脏纤维化程度分级为S1-4级25.86%,39.66%,5.17%,29.31%;HBV三组不同基因型的慢性乙型肝炎患者肝组织病理检查有统计学意义(x^2=15.13,P<0.01).HBV B型与B/C型感染患者年龄在21-30岁组58%-76%,31-40岁组17.6%-29.4%,C型感染患者年龄在21-30岁组25%,31-40岁组46.6%,40岁以上有24.24%;不同HBV基因型感染患者的年龄分布有显著性差异(x^2=9.54,P<0.05).结论:慢性乙型肝炎患者HBV基因型中C型比例明显高于B型与B/C型.HBV C型患者肝脏病理变化较B型与B/C型严重.不同HBV基因型感染患者的年龄分布不同.AIM： To investigate the relationship between hepatitis B virus DNA genotype and pathological changes in patients with chronic hepatitis B. METHODS： A total of 92 chronic hepatitis B （CHB） patients were tested for HBV genotype and sub-genotypes by nested and fluorescence quantitative polymerase chain reactions, re-spectively. Liver biopsy specimens of all patients were taken and histological activity index （HAI） necroinflammation （HAI-NI）, and fibrosis （HAI-F） scores were calculated. RESULTS： Among the 92 cases, 17 （18.48%） had genotype B （sub-genotype B2）, 17 （18.48%） had mixed B/C genotype （sub-genotype B2/Ca） and 58 （63.04%） had C （sub-genotype Ca） infections.In the 17 CHB patients with genotype B, HAI- NI were 35.29%, 58.82% and 5.88% for G1, G2 and G3, respectively, HAI-F scores were 58.82%, 29.41% and 11.76% for S1, S2, and S3, respectively; In the 17 cases with mixed B/C genotype in- fection, HAI-NI were 35.29%, 52.94% and 11.76% for G1-G3, respectively, HAI-F were 23.52%, 52.94%, 23.52% for S1-S3, respectively; In the 58 patients with genotype C, HAI-NI was 31.03%, 24.14%, 36.21% and 8.62% for G1-G4, respectively, HAI-F were 25.86%, 39.66%, 5.17%, 29.31% for S1-S4, respectively. There were significantly differences in the HAI-NI and HAI-F scoring in patients with different HBV genotypes （χ^2 = 15.13, P 〈0.01）. The ages of CHB patients were significantly different between the HBV genotypes C and B. The frequencies were 58%-76% for those 21-30 years old, 17.6%-29.4% for 31-40 in genotype B, and 25% for 21-30 years old, 46.6% for 3140, and 24.24% for 〉 40 in genotype C （χ^2= 9.54, P 〈 0.05）. CONCLUSION： The most common HBV genotype was C. Patients with HBV C had severer in- fections than those of other genotypes. Further, different HBV genotypes infected different ages of HBV patients.

关 键 词：乙型肝炎病毒 慢性乙型肝炎 基因型 病理学 巢氏聚合酶链式反应 荧光定量聚合酶链式反应 

分 类 号：R512.62[医药卫生—内科学]