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目的了解儿童乙型肝炎病毒(HBV)基因型与临床分度的关系。方法选择甘肃省人民医院儿科和兰州大学第一医院感染科2008年4月至2010年4月门诊和住院患儿中HBV-DNA阳性的124例乙型肝炎患儿,其中男84例,女40例。HBV携带者65例,慢性乙型肝炎59例(轻度31例、中度18例、重度10例),对以上患儿进行基因分型、同时检测肝功、术前出凝血、HBV-DNA载量。结果 124例肝病患儿中,C基因型62例(50.0%),B基因型48例(38.7%),B/C混合型9例(7.3%),非B/C型5例(4.0%);HBV携带者和轻度组中,以B基因型为主,分别为47.7%和45.2%;中度和重度组中,以C基因型为主,分别为72.2%和80%;在C、B基因型分布方面,HBV携带者和轻度组与中度和重度组比较差异有统计学意义;C基因型患者的HBV-DNA载量、丙氨酸转氨酶(ALT)、天冬氨酸转移酶(AST)、总胆红素(TBIL)均高于B基因型;C基因型患者与B基因型比较,凝血酶原时间(PT)延长、凝血酶原活动度(PTA)下降、纤维蛋白原(FIB)减少。B、C型通过母婴传播的比例差异无统计学意义。结论甘肃省儿童乙型肝炎病毒基因型以C、B型为主,以C基因型为优势。C基因型患儿的肝功损害较B基因型严重且病毒载量也高。儿童乙肝病毒基因型的检测对指导治疗、评估预后及早期预防具有非常重要的意义。
Objective To understand the relationship between hepatitis B virus (HBV) genotype and clinical index in children. Methods A total of 124 hepatitis B patients with HBV-DNA positive from outpatients and inpatients from April 2008 to April 2010 in Department of Infectious Diseases, People’s Hospital of Gansu Province and First Hospital of Lanzhou University were enrolled. Among them, 84 were male and 40 were female example. 65 cases of HBV carriers, 59 cases of chronic hepatitis B (31 cases of mild, 18 cases of moderate and 10 cases of severe). The patients were genotyped, and liver function, preoperative coagulation, HBV-DNA Load. Results Among 124 children with liver disease, 62 (50.0%) were C genotypes, 48 (38.7%) were B genotypes, 9 (7.3%) were B / ). In HBV carriers and mild group, the genotypes of B were mainly 47.7% and 45.2% respectively. Among the moderate and severe groups, C genotype was the major one, which was 72.2% and 80% , B genotype distribution, HBV carriers and mild group compared with the moderate and severe groups, the difference was statistically significant; C genotype HBV-DNA load, alanine aminotransferase (ALT), aspartate AST and TBIL were higher than those of B genotype. Prothrombin time (PT) and prothrombin activity (PTA) were decreased in patients with genotype C compared with genotype B, Reduced protein (FIB). B, C type of mother-to-child transmission of the difference was not statistically significant. Conclusion The genotypes of hepatitis B virus in children in Gansu Province are mainly C and B genotypes, and genotype C is the dominant genotype. Children with C genotype had severe liver damage compared with B genotype and high viral load. Detection of childhood hepatitis B virus genotypes is very important for guiding treatment, assessing prognosis and early prevention.