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目的探讨慢性乙型肝炎病毒(hepatitis B virus,HBV)感染者前核心区(precore,PC)和基本核心启动子(basalcore promoter,BCP)变异特点以及变异株血清乙肝病毒e抗原(hepatitis B e antigen,HBeAg)、乙肝病毒表面抗原(hepatitis B surface antigen,HBsAg)、乙肝病毒脱氧核酸(HBV-DNA)检测的临床意义。方法采集138例慢性HBV感染者清晨空腹血,以免疫化学发光法检测血清HBeAg、HBsAg,并同时采用磁珠法检测HBV-DNA,应用半巢式聚合酶链反应检测PC/BCP区基因突变。结果 101例未经抗病毒治疗的慢性HBV感染者中,HBeAg阴性组PC、BCP、PC+BCP变异率高于HBeAg阳性组,差异有统计学意义(P<0.05)。37例服用核苷类药物一年以上组PC、BCP、PC+BCP检出率要高于未经抗病毒治疗的HBeAg阳性HBV感染者组(P<0.05)。HBeAg阴性HBV感染患者其PC、BCP和PC+BCP的变异率随着病程的增加而增加(P<0.01)。PC、BCP和PC+BCP变异株组与野生株比较,慢性HBV感染者HBeAg含量减少(P<0.05),DNA复制活跃、HBsAg含量增加(P<0.01)。结论变异的发生使HBeAg阴性的慢性HBV感染患者越来越多,服用核苷类抗病毒药物和长的疾病病程可能是变异相关因素。对于HBeAg阴转的慢性HBV感染患者观察DNA、HBsAg含量,可了解体内病毒是否确实已被免疫清除。
Objective To investigate the variation characteristics of precore (PC) and basalcore promoter (BCP) in patients with chronic hepatitis B virus (HBV) infection and the clinical significance of hepatitis B e antigen (hepatitis B e antigen) , HBeAg), hepatitis B surface antigen (HBsAg) and hepatitis B virus deoxyribonucleic acid (HBV-DNA). Methods Fasting blood samples were collected from 138 patients with chronic HBV infection. Serum HBeAg and HBsAg were detected by immunochemical chemiluminescence assay. HBV-DNA was detected by magnetic beads method. Semi-nested polymerase chain reaction was used to detect PC / BCP gene mutations. Results The mutation rate of PC, BCP and PC + BCP in 101 patients with chronic HBV infection without antiviral therapy was significantly higher than that in HBeAg-positive patients (P <0.05). The detection rate of PC, BCP and PC + BCP in 37 patients taking nucleoside drugs for more than one year was higher than that of HBeAg-positive HBV patients without antiviral therapy (P <0.05). The mutation rates of PC, BCP and PC + BCP in patients with HBeAg-negative HBV infection increased with the course of disease (P <0.01). The levels of HBeAg in PC, BCP and PC + BCP mutant groups were significantly lower than those in wild type (P <0.05), DNA replication was active and HBsAg level was increased (P <0.01). Conclusion The occurrence of mutation makes HBeAg-negative patients with chronic HBV infection more and more, taking nucleoside antiviral drugs and long disease course may be related to mutation. For HBeAg-negative patients with chronic HBV infection observed DNA, HBsAg content, can understand whether the virus has indeed been immune clearance.