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目的探讨乙型肝炎病毒(HBV)前核心区(前C区,nt1896)及基本核心启动子(BCP,nt1762/1764)变异在慢性HBV感染者疾病谱的分布及对患者疾病谱的影响。方法416例血清HBsAg阳性、HBVDNA定量大于1.0×104拷贝/毫升的患者,采用微流基因芯片检测HBV前C区及BCP变异。结果416例HBV感染者中302例为HBeAg(-)患者,其中248例(82.12%)有前C区或BCP变异,41.06%为前C区变异,31.12%BCP变异,2种同时变异为9.94%。HBeAg(-)的慢性乙型肝炎和肝硬化患者前C区变异分别为64.72%和83.33%(x2=0.89,P>0.05),均大于HBeAg(-)无症状携带者的28.47%(x2=54.20,P<0.01;x2=5.29,P<0.05);而HBeAg(-)无症状携带者BCP变异达77.19%,大于HBeAg(-)慢性乙型肝炎和肝硬化患者(x2=69.73,P<0.01;x2=10.58,P<0.01)。而在114例HBeAg(+)患者中28.95%有前C区或BCP变异。结论前C区或BCP变异在慢性HBV感染者疾病谱的分布不同,在HBeAg(-)/HBVDNA(+)与HBeAg(+)/HBVDNA(+)患者变异率差异显著。HBV前C区可能是该病变反复及加重的一个重要原因,但BCP变异临床意义不明确。
Objective To investigate the distribution of disease spectrum in patients with chronic HBV infection and the influence on the disease spectrum of hepatitis B virus (HBV) precore (precore C, nt1896) and basic core promoter (BCP, nt1762 / 1764). Methods 416 cases of patients with positive serum HBsAg and HBVDNA of more than 1.0 × 104 copies / ml were tested for the presence of pre-HBV C and BCP by using microfluidic microarray. Results Of 416 patients with HBV infection, 302 were HBeAg-positive patients, of whom 248 (82.12%) had pre-C or BCP variation, 41.06% were pre-C-region variation, 31.12% were BCP-variant and 2 were 9.94 %. The pre-C region variation of patients with chronic hepatitis B and cirrhosis with HBeAg (-) was 64.72% and 83.33%, respectively (x2 = 0.89, P> 0.05), which were significantly higher than those of HBeAg- 54.20, P <0.01; x2 = 5.29, P <0.05). The BCP variation of asymptomatic carriers of HBeAg was 77.19%, which was higher than that of patients with HBeAg (-) chronic hepatitis B and cirrhosis (x2 = 0.01; x2 = 10.58, P <0.01). While 28.95% of 114 patients with HBeAg (+) had pre-C or BCP variability. Conclusion The distribution of disease spectrum in patients with chronic HBV infection is different in pre-C region or BCP mutation, and there is significant difference in mutation rate between HBeAg (-) / HBVDNA (+) and HBeAg (+) / HBVDNA Pre-HBV precinct may be an important reason for the repeated and exacerbation of the disease, but the clinical significance of BCP mutation is not clear.