不同基因型HBV感染的慢性乙型肝炎患者临床与病理改变研究

Research on clinical and pathological changes of chronic hepatitis Bpatients infected with different hepatitis B virus genotypes

摘要:

目的：探讨不同基因类型的慢性乙型肝炎（Chronic hepatitis B,CHB）患者在年龄、性别和民族方面的内在关联，比较不同HBV基因类型患者的肝组织病理损害程度、HBV-DNA载量及肝功能改变。方法：荧光定量PCR仪检测94例行肝活检的CHB患者的HBV-DNA,以限制性片段长度多态性(Restriction fragment length polymorphism,RFLP)方法进行HBV基因分型。结果：本组94例CHB患者B基因型占74.5%，C基因型占25.5%。HBV基因类型与年龄、性别无关；C基因型中壮族所占比例明显高于B基因型；C基因型患者HBeAg阳性率明显低于B基因型患者（P<0.05）。CHB患者肝组织病理损伤程度与B、C基因型相关，C基因型在肝组织炎症及纤维化程度较重组所占的比例高于B基因型（P<0.05）；肝组织病理损伤程度与肝功能指标相关（P<0.05），但与HBV-DNA水平无关。结论：本组CHB患者HBV基因类型呈B、C 2型，人群分布以B型为主，C型次之，未见其他类型或混合型；汉族患者以B基因型为主，壮族则以C型为主；相对于B基因型，C型患者肝组织炎症及纤维化程度较重，容易出现严重的肝损害和肝癌等不良预后。

Abstract:

Objective:To investigate the relationship of ages,genders and nationalities in chronic hepatitis B (CHB) patients infected with different hepatitis B virus,to compare the hepatic tissue damage degree,HBV-DNA load and the liver function change among patients with different genotype.Methods:Fluorescence quantitative polymerase chain reaction (PCR) instrument was used to test HBV-DNA and restriction fragment length polymorphism (RFLP) method was used to test genotypes.Results:Among 94 patients with CHB,B genotype was accounted for 74.5% and C genotype for 25.5%.CHB patients HBV genotype had nothing to do with age and sex.The proportion of Zhuang nationality in C genotype was obviously higher than that in B genotype.The HBeAg positive rate of patients with C genotype was obviously lowered than that of patients with B genotype(P<0.05).The pathological damage degree of the hepatic tissue was correlated with B and C genotype.The proportion of C genotype in the hepatic tissue with serious inflammation and fibrosis was higher than that in B genotype(P<0.05) .The hepatic tissue damage degree was correlated with liver function indexes(P<0.05),but not HBV DNA levels. Conclusion:The HBV genotypes of enrolled CHB patients is B genotype and C genotype B genotype is mainly distributed among the population,followed by C genotype,other types or mixed types are not found yet.The patients with Han nationality is mainly B genotype and those with Zhuang nationality is primarily C genotype.Patients with C genotype have serious hepatic inflammation and fibrosis and are prone to induce servere liver damage and adverse prognosis such as liver cancer.