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目的 了解常州地区乙型肝炎病毒基因型分布特征 ,探讨其基因型与肝功能损伤、病毒复制水平及对拉米夫定疗效的关系。方法 采用巢式聚合酶链反应 (nest PCR) ,扩增乙型肝炎病毒S基因区 ,用末端标记方法对PCR产物标记并直接测序 ,测序结果和GenBank中登录的标准基因型序列相比较。结果 对该地区 14 6份不同HBV感染者血清HBVDNA进行了基因分型 ,B型 5 1份 (34 9% ) ,C型 95份 (6 5 1% ) ,未发现B、C以外其他基因型 ;丙氨酸转氨酶 (ALT)水平分别为 383 8± 335 7IU和36 4 3± 333 7IU ,(t=0 335 ,P >0 .0 5 )、HBVDNA含量分别为 10 7 795± 1 2 2 和 10 7.6 9± 1 .1 9拷贝 毫升 (t=0 .138,P >0 0 5 )、HBeAg阳性数分别为 36 5 1和 6 4 95 ,(χ2 =0 .15 9,P >0 .0 5 ) ;10 4例慢性乙型肝炎中B型为 4 3例、C型为 6 1例 ,2 8例肝硬化和肝癌患者检出B型 4例、C型 2 4例 ,二组比较 χ2 =7 6 5 ,P <0 .0 1;2 3例B基因型患者和 4 5例C基因型患者接受 4 8周以上拉米夫定治疗 ,4 8周后反跳者B型为 18例 ,C型为 14例 ,χ2 =13.4 9,P <0 .0 0 1.结论 本地区HBVDNA基因型为B型和C型 ;二种基因型丙氨酸转氨酶水平、病毒复制水平和HBeAg表达水平差异均无显著性 ;C基因型与肝硬化和肝癌关系密切 ;拉米夫定对C?
Objective To understand the distribution of hepatitis B virus genotypes in Changzhou and to explore the relationship between genotypes and liver function impairment, viral replication and efficacy of lamivudine. Methods Nest PCR was used to amplify the S gene region of hepatitis B virus. The PCR products were labeled and sequenced directly by end-labeling. The sequencing results were compared with the standard genotypes registered in GenBank. Results Serum HBVDNA was genotyped in 14 6 HBV infected patients in this area. There were 51 cases of type B (95%) and 95 cases (95%) of type C, no genotypes other than B and C were found ; The levels of alanine aminotransferase (ALT) were 383 8 ± 335 7IU and 36 4 3 ± 333 7IU respectively (t = 0 335, P> 0.05), and the levels of HBVDNA were 10 7 795 ± 1 2 2 and 10 7.69 ± 1.11 copies ml (t = 0.138, P> 0.05). The positive HBeAg numbers were 36 5 1 and 6 4 95, respectively (χ2 = 0.159, P> 0 .0 5). Among 10 4 chronic hepatitis B cases, 43 were type B, 61 were type C, 4 were type B and 24 were type C in 28 patients with cirrhosis and hepatocellular carcinoma, and those in group C were 2 = 76.5, P <0.01; 23 patients with genotype B and 45 patients with genotype C received lamivudine for more than 48 weeks, and those with rebound type B after 48 weeks had 18 cases , 14 cases of type C, χ2 = 13.49, P <0 0 01. Conclusions The genotypes of HBVDNA in this area are B and C. The levels of alanine aminotransferase, viral replication and HBeAg in the two genotypes The difference was not significant; C genotype and liver cirrhosis and liver cancer are closely related; lamivudine on C?