长春市702例HBV感染者的病毒基因分型及临床意义  

HBV genotyping of 702 hepatitis B patients in Changchun,China and its clinical significance

作　　者：袁野[1] 于雪娇[1] 卢念红 张明威[2] 

机构地区：[1]吉林大学第一医院,长春130021 [2]吉林大学第二医院,长春130041

出　　处：《临床肝胆病杂志》2016年第11期2103-2106,共4页Journal of Clinical Hepatology

摘　　要：目的了解长春市HBV基因型的分布情况,分析不同基因型与病毒复制水平、血清标志物及肝损伤的关系及临床意义。方法收集2013年8月-2016年5月于吉林大学第一医院就诊的HBV感染者702例,采用real-time PCR法检测HBV基因型,并检测HBV DNA载量、血清标志物及肝功能,分析基因型与临床检测项目的相关性。计量资料组间比较采用独立样本t检验;计数资料组间比较采用χ2检验。HBV基因型在不同疾病中的分布选用Mann-Whitney U检验。结果 702例HBV感染者中成功分型664例,其中C基因型484例(72.9%),B基因型168例(25.3%),B+C基因型12例(1.8%)。HBV基因型分布无性别、年龄差异。C基因型感染者HBV DNA载量为(6.68±1.20)log10拷贝/ml,显著高于B基因型(5.15±1.37)log10拷贝/ml,差异有统计学意义(t=13.714,P<0.001);C基因型HBsAg(+)+HBeAg(+)+抗-HBc(+)高于B基因型,差异有统计学意义(χ2=21.687,P<0.001);但HBsAg(+)+抗-HBe(+)+抗-HBc(+)两者间差异无统计学意义(χ2=2.124,P=0.145);B基因型HBsAg和抗-HBc双阳性率显著高于C基因型(χ2=28.780,P<0.001)。C基因型感染者ALT、AST水平显著高于B基因型[(307.6±113.4)U/L vs(285.8±96.2)U/L,(211.1±96.4)U/L vs(192.7±89.2)U/L],差异有统计学意义(t值分别为2.229、2.172,P值分别为0.026、0.030)。C基因型感染者Alb水平(37.6±9.1)g/L低于B基因型(39.9±10.6)g/L,差异有统计学意义(t=2.701,P=0.007)。C基因型感染者发展为慢性肝炎264例,肝硬化202例,肝癌18例,B基因型感染者发展为慢性肝炎142例,肝硬化20例,肝癌6例,前者对肝脏的损伤程度强于后者,差异有统计学意义(U=28 894.000,P<0.001)。结论长春市HBV感染者以C基因型为主,B基因型次之。HBV基因型与性别、年龄差异无关。C基因型感染者的HBV DNA复制较为活跃,与肝损伤严重程度的相关性高于B基因型。Objective To investigate the distribution of HBV genotypes in Changchun,China,as well as the association of genotypes with virus replication level,serum markers,and liver impairment and its clinical significance. Methods A total of 702 patients with HBV infection who visited The First Hospital of Jilin University from August 2013 to May 2016 were enrolled. Real- time PCR was used to determine HBV genotypes. HBV DNA load,serum markers,and liver function were measured,and the association between genotype and clinical test items was analyzed. The independent samples t- test was used for the comparison of means between groups,and the chi- square test was used for comparison of categorical data between groups. The Mann- Whitney U test was used to investigate the distribution of HBV genotypes in different diseases. Results Of all patients with HBV infection,664 underwent successful genotyping,among whom 484（ 72. 9%） had genotype C,168（ 25. 3%） had genotype B,and 12（ 1. 8%） had genotype B ＋ C. There were no differences in the distribution of HBV genotypes between patients with different sexes or ages. Compared with those with genotype B HBV infection,the patients with genotype C HBV infection had significantly higher HBV DNA load（ 6. 68 ± 1. 20 log10 copies / ml vs 5. 15 ± 1. 37 log10 copies / ml,t = 13. 714,P〈0. 001） and HBsAg（ ＋） ＋ HBeAg（ ＋） ＋ anti- HBc（ ＋）（ χ2= 21. 687,P〈0. 001）. There was no significant difference in HBsAg（ ＋） ＋ anti- HBe（ ＋） ＋ anti- HBc（ ＋）between the two groups（ χ2= 2. 124,P = 0. 145）. The patients with genotype B had significantly higher levels of HBsAg and anti- HBe than those with genotype C（ χ2= 28. 780,P〈0. 001）. Compared with those with genotype B,the patients with genotype C had significantly higher levels of alanine aminotransferase（ ALT） and aspartate aminotransferase（ AST）（ ALT： 307. 6 ± 113. 4 U / L vs 285. 8 ± 96. 2 U / L,t = 2. 229,P = 0. 026; AST： 211. 1 ± 96. 4 U / L vs 192. 7 ± 89

关 键 词：肝炎病毒 乙型 基因型 生物学标记 

分 类 号：R512.62[医药卫生—内科学]