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目的:了解云南地区乙型肝炎病毒基因型分布特征,探讨其与慢性HBV感染者的性别和年龄、不同临床疾病谱、病毒复制水平的关系.方法:选择云南地区慢性HBV感染者117例其中慢性无症状乙型肝炎表面抗原携带者(ASC)26例、慢性乙型肝炎(CHB)55例(轻度21例、中度24例、重度10例)、慢性重型肝炎(CLF)18例、乙肝后肝硬化(LC)11例及原发性肝细胞肝癌(HCC)7例,采用反向杂交技术(RDB)检测HBV基因型,并对与其性别年龄、临床分型和病毒复制水平的关系进行分析.结果:云南地区HBV基因型以B型和C型为主,分别为41.0%(48/117)和54.7%(64/117),并以C型为最多(χ2=4.38,P=0.036);D型1例(0.86%),B、C混合型2例(1.71%),A、C混合型2例(1.71%).B基因型在轻度慢乙肝组所占的比例显著高于中、重度慢乙肝组(χ2=8.27、11.98,P=0.004、0.001)、ASC组(χ2=5.46,P=0.02)、CLF组(χ2=4.13,P=0.042)和LC/HCC组(χ2=11.3,P=0.001).C基因型在LC/HCC组和重度慢乙肝组所占的比例均显著高于轻度慢乙肝组(χ2=11.3,P=0.001;χ2=8.78,P=0.003),与其他各临床型组间的比较则无显著性差异(P>0.05).C基因型在HBVDNA(+)组和HBeAg(-)组r所占的比例均分别显著高于HBVDNA(-)组(χ2=6.63,P=0.01)和HBeAg(+)组(χ2=7.12,P=0.008).B基因型在HBVDNA低水平复制组中所占的比例显著高于高水平复制组(χ2=4.12,P=0.042).C基因型在HBVDNA高水平复制组中所占的比例显著高于B基因型(χ2=5.13,P<0.05).C基因型在年龄≥30岁组中所占的比例(63.3%)高于年龄<30岁组(45.6%)(χ2=3.7,P=0.05).HBV基因型在性别间的分布无统计学差异(P>0.05)结论:云南地区存在HBV的B、C、D、B+C和A+C基因型,以B型和C型为主要基因型,并以C型为最多.B基因型在轻度慢乙肝的比例显著高于其他各临床型HBV感染者,并且与HBV的低水平复制和低年龄有关.C基因型主要分布于重度慢乙肝和LC/HCC、HBVDNA高水平复制、年龄≥30岁的患者中.提示C基因型与慢乙肝重度、肝硬化、肝细胞肝癌及HBVDNA高水平复制关系密切.
Objective: To understand the distribution of hepatitis B virus genotypes in Yunnan and to explore its relationship with the gender and age of patients with chronic HBV infection, different clinical disease spectrum and viral replication.Methods: A total of 117 patients with chronic HBV infection in Yunnan were selected, including chronic Sixteen asymptomatic hepatitis B surface antigen carriers (ASC), 55 CHB (21 mild, 24 moderate, 10 severe), 18 chronic severe hepatitis (CLF), hepatitis B 11 cases of post-cirrhosis (LC) and 7 cases of primary hepatocellular carcinoma (HCC). The HBV genotypes were detected by reverse hybridization (RDB), and their relationship with sex, age, clinical classification and viral replication Results: The genotypes of HBV genotypes in Yunnan were mainly B type and C type, which were 41.0% (48/117) and 54.7% (64/117) respectively, with the highest genotype C (χ2 = 4.38, P = 0.036 ), 1 case (0.86%) in D type, 2 cases (1.71%) in B and C mixed type and 2 cases (1.71%) in mixed type A and C.The proportion of B genotype in mild chronic hepatitis B group was significantly higher (P = 0.004,0.001) in ASC group (χ2 = 5.46, P = 0.02), CLF group (χ2 = 4.13, P = 0.042) and LC / HCC group (χ2 = 8.27,11.98, χ2 = 11.3, P = 0.001) .C genotypes in the LC / HCC group And severe chronic hepatitis B group were significantly higher than mild chronic hepatitis B group (χ2 = 11.3, P = 0.001; χ2 = 8.78, P = 0.003), compared with other clinical groups showed no significant difference (P> 0.05) .The proportion of genotype C in HBVDNA group and HBeAg group was significantly higher than that in HBVDNA group (χ2 = 6.63, P = 0.01) and HBeAg (Χ2 = 7.12, P = 0.008) .B genotype in HBVDNA low-copy group was significantly higher than the high-level copy group (χ2 = 4.12, P = 0.042) .C genotype in the high level of HBVDNA replication (Χ2 = 5.13, P <0.05) .The proportion of C genotype in age≥30 years group (63.3%) was higher than that in age <30 years old group (45.6% ) (χ2 = 3.7, P = 0.05). There was no significant difference in gender distribution between HBV genotypes (P> 0.05) .Conclusion: There are HBV genotypes B, C, D, B + C and A + C in Yunnan , With genotypes B and C as the main genotype and genotype C as the most.A genotype of B genotype was significantly higher than that of other clinical HBV genotypes in mild chronic HBV infection and was associated with low level of HBV replication and low age About. C genotypes are mainly distributed in severe chronic hepatitis B and LC / HCC, HBVDNA high-level replication, age ≥30 Of patients, suggesting that chronic hepatitis C genotype and severe, cirrhosis, hepatocellular carcinoma and HBVDNA close high-level replication.