慢性乙型肝炎乙型肝炎病毒核心启动子区和前核心区基因变异后的预后分析

目的 为了解慢性乙型肝炎患者乙型肝炎病毒(HBV)核心启动子(BCP)区和前核心(前C)区基因变异后的临床转归及其预后。方法 采用DNA序列分析法检测123例HBV DNA阳性的慢性乙型肝炎患者血清HBV BCP区(nt1762、nt1764)和前C区(nt1896)基因序列，并同步进行乙型肝炎e抗原(HBeAg)、乙型肝炎e抗体(抗-HBe)定量及肝功能检测。结果 123例患者HBV BCP区(A1762T、G1764A)和前C区(G1896A)基因变异检出率为76.42％；其中肝炎肝硬化(HLC)患者双变异(A1762T、G1764A)和联合变异(A1762T、G1764A、G1896A)率最高(52．94％与29．41％)；慢性重型肝炎患者终止变异(G1896A)率最高(42．86％)；HBeAg／抗HBe转换率分别为：双变异组23.91％，终止变异组75．00％，联合变异组84．00％，无变异组13．79％。结论 HBV BCP双变异、前C终止变异和联合变异均可引起慢性乙型肝炎病情加重及肝硬化的发生，但严重肝损伤与这3种变异之间可能无因果关系，只是HBV减少病毒蛋白的产生，逃避免疫监视的一种方式；推测BCP双变异和联合变异可能是引起HLC的重要病因之一；BCP区变异患者时干扰素治疗敏感。

Analysis of prognosis in patients with mutations of core promoter and precore gene of hepatitis B virus

Objective To study the clinical outcome and prognosis in the patients with the mutations of core promoter(CP) and the precore gene of hepatitis B virus(HBV). Methods CP and precore gene mutations were observed in 123 patients with HBV DNA positive.At the same time the serum HBeAg and Anti-HBe concentration and liver function were tested.Results The rate of CP and precore gene mutations was (76.42%).The rate of double mutations (nt1762,nt1764) and mutations in nt1762,nt1764,nt1896 was highest((52.94%) and (29.41%)) in hepatitis liver cirrhosis (HLC) patients.The rate of terminated mutations was highest in chronic severe hepatitis B patients((42.86%)).The rate of HBeAg/Anti-HBe was (23.91%) with double mutations,and (75.00%) with termination mutations,(84.00%) with nt1762,nt1764,nt1896 mutations,(13.79%) with no mutation.Conclusion All mutations can lead to severe hepatitis and liver cirrhosis,but there were no relations between three types of mutations and severe liver hurt.Only because the protein of virus was reduced,it was the way of immunosurveillance.The double mutations and nt1762,nt1764,nt1896 mutations were one reason of HLC.The patients with nt1762,nt1764 mutations were sensitive to interferon treatment.