昆明地区HBsAg与抗-HBs双阳性慢性HBV感染患者流行病学调查及PreS/S基因突变特征  

Epidemiological investigation and mutation characteristics of pres/s gene in patients with chronic HBV infection with double positive HBsAg and anti HBS in the region

作　　者：白丽萍 张颖慧 杨雪艳 白丽仙 马志坚 BAI Liping;ZHANG Yinghui;YANG Xueyan;BAI Lixian;MA Zhijian(Department of Gastroenterology,The Affiliated Hospital of Yunnan University,Kunming 650021,China;Department of Pediatrics,Yuxi People′s Hospital,Yuxi 653199,Yunnan,China;Department of Emergency,The First People′s Hospital of Kunming,Kunming 650031,China)

机构地区：[1]云南大学附属医院消化内科,云南昆明650021 [2]玉溪市人民医院儿科,云南玉溪653199 [3]昆明市第一人民医院急诊科,云南昆明650031

出　　处：《西部医学》2023年第12期1793-1797,共5页Medical Journal of West China

基　　金：云南省基础研究计划(2019FE001)。

摘　　要：目的探讨昆明地区HBsAg与抗-HBs(Anti-HBs)双阳性乙型肝炎病毒(HBV)感染患者流行病学及PreS/S基因突变特征。方法选择2018年5月—2022年4月于云南大学附属医院住院及门诊定量检测乙肝两对半的438例慢性HBV感染患者为观察对象,将202例HBsAg(+)/抗-HBs(+)患者作为观察组,将236例HBsAg(+)/抗-HBs(-)患者作为对照组,对比两组患者临床特征。使用巢式聚合酶链反应扩增出PreS/S基因全长序列,确定基因型并分析PreS/S基因突变特征。结果观察组患者在<10岁及高于80岁人群中的流行率较高,而对照组在20~49岁人群中的流行率较高。与对照组比较,观察组患者年龄、HBsAg<250 IU/mL比例、C型HBV感染及乙肝携带者比例均显著增加(P<0.05)。成功扩增PreS/S并测序成功的观察组样本共132例,其中B型基因81例,C型基因51例;对照组样本中B型基因110例,C型基因65例。B型基因患者中,与对照组比较,观察组N末端区域突变率明显增加(P<0.05)。C型基因患者中,与对照组比较,观察组MHR、a决定簇及N末端区域突变率明显增加(P<0.05)。在观察组中,81例B型基因患者中PreS基因缺失突变14例(17.28%),51例C型基因患者中PreS基因缺失突变19例(37.25%),而在对照组中未发现PreS基因缺失突变。结论HBsAg/抗-HBs双阳性HBV感染者在<10岁及高于80岁HBsAg阳性人群多见,HBsAg/抗-HBs双阳性可能与HBsAg突变及PreS基因突变有关。Objective To investigate the epidemiology and mutation characteristics of pres/s gene in patients with hepatitis B virus(HBV)infection with double positive HBsAg and anti HBS(anti HBS)in Kunming area.Methods From May 2018 to April 2022,438 patients with chronic HBV infection who quantitatively detected two and a half pairs of hepatitis B in our hospital and outpatient department were selected as the research objects.202 HBsAg(+)/anti HBS(+)double positive patients were taken as the experimental group,and 236 HBsAg(+)/anti HBS(-)patients were taken as the control group.The difference of clinical data between the two groups were analyzed.The full-length sequence of pres/s gene was amplified by nested polymerase chain reaction,and the genotype was determined and the mutation characteristics of pres/s gene were analyzed.Results The prevalence rate of patients in the experimental group is higher in the population aged<10 and above 80,while the prevalence rate of patients in the control group is higher in the population aged 20-49.Compared with the control group,the age of patients in the experimental group,the proportion of HBsAg<250iu/ml,the infection of type C HBV and the proportion of hepatitis B carriers were significantly increased(P<0.05).A total of 132 HBsAg(+)/anti HBS(+)samples were successfully amplified and sequenced,including 81 B-type genes and 51 C-type genes;In HBsAg(+)/anti HBS(-)samples,there were 110 cases of B-type gene and 65 cases of C-type gene.In patients with type B gene,the mutation rate of N-terminal region in double positive group was significantly higher than that in single positive group(P<0.05).In patients with type C gene,compared with the single positive group,the mutation rates of MHR,a determinant and N-terminal region in the double positive group were significantly increased(P<0.05).Among 81 patients with type B gene,14(17.28%)had deletion mutation of pres gene,and 19(37.25%)had deletion mutation of pres gene in 51 patients with type C gene,but no deletion mutation of pres gene was f

关 键 词：乙型肝炎病毒 乙型肝炎病毒表面抗原 抗乙型肝炎病毒表面抗原抗体 PreS/S区基因 突变 

分 类 号：R512.62[医药卫生—内科学]