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目的测定慢性乙型肝炎病毒(HBV)感染者HBV DNA全序列,分析S区基因缺失模式、频率及相关因素。方法慢性HBV感染者59例,其中HBV携带7例,慢性肝炎31例,肝硬化10例,重型肝炎6例,原发性肝癌5例。结果25.4%(15/59)慢性HBV感染者有S区基因缺失,未发现S基因缺失。Pre-S基因缺失均见于C基因型患者。Pre-S基因缺失患者中,20%(3/15)HBsAg、抗HBs共存,与无S区缺失者比较有明显差异(P<0.05)。PreS基因缺失与病程(偏相关系数0.28,P=0.049)、抗病毒治疗(偏相关系数-0.451,P=0.036)有密切关系。结论Pre-S基因缺失在基因C型、严重肝病及活动性HBV复制患者多见,可能与病程长及抗病毒治疗有关。Pre-S基因缺失可导致HBV免疫逃避或免疫治疗失败,可能是肝脏疾病发展的重要原因。
Objective To determine the HBV DNA sequence in patients with chronic hepatitis B virus infection and analyze the gene deletion pattern, frequency and related factors in S region. Methods 59 cases of chronic HBV infection, including HBV carrier in 7 cases, 31 cases of chronic hepatitis, cirrhosis in 10 cases, 6 cases of severe hepatitis, 5 cases of primary liver cancer. Results 25.4% (15/59) patients with chronic HBV infection had deletion of S region gene and no S gene deletion was found. Pre-S gene deletion are found in C genotype patients. 20% (3/15) HBsAg and anti-HBs co-existed in patients with Pre-S deletion, compared with those without deletion (P <0.05). PreS gene deletion and duration of disease (partial correlation coefficient 0.28, P = 0.049), anti-viral treatment (partial correlation coefficient -0.451, P = 0.036) are closely related. Conclusion The deletion of Pre-S gene is more common in patients with genotype C, severe liver disease and active HBV replication, which may be related to longer course and antiviral therapy. Pre-S gene deletion can lead to HBV immune escape or failure of immunotherapy may be an important cause of liver disease.