福建省部分地区乙型肝炎病毒基因型分布及其临床意义

目的首次调查福建省5个地区乙型肝炎病毒(HBV)基因型的分布状况,并探讨HBV基因型与HBV相关肝病临床的可能相关性.方法收集福州市、厦门市、泉州市、三明市、莆田市等地区慢性HBV感染者的血清,采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)法检测HBV基因型,应用多因素logistic回归分析、对应分析研究HBV基因型与临床的相关性.结果 431例HBV DNA阳性血清中基因B型275例(63.8%),C型100例(23.2%),D型及其混合型共51例(11.8%),未见A、E、F型.多因素logistic回归分析显示,泉州和三明地区HBV基因B型所占比例显著高于福州地区(P=0.002;P=0.006);无症状携带者、慢性肝炎、重型肝炎组都是以基因B型为主要基因型;基因C型在肝硬化中所占比例(47.0%)显著高于无症状携带者(14.5%)和重型肝炎组(14.7%)(P=0.009;P＜0.001);基因B型的e抗原阳性率(52.4%)显著低于C型(56.0%)(P=0.008);基因D型患者e抗原阳性率(30.8%)也低于C型(P=0.051).对应分析表明原发性肝癌(HCC)与基因D型及其混合型关系密切.结论 (1)福建省HBV感染以基因B型为主,其次是C型,也存在基因D型的流行.(2)福建省部分地区基因型B和C的分布可能存在差异.(3)基因B型在年轻患者中可能与重型肝炎的发展有关;基因C型在年长患者中可能更易导致肝硬化.(4)基因D型与HCC可能有一定的相关性,值得进一步研究.

Distribution of hepatitis B virus genotype in 5 cities of Fujian province and the clinical implications of HBV genotype

OBJECTIVE: To study the prevalence of hepatitis B virus (HBV) genotype in 5 cities of Fujian province and the clinical implications of distinct genotypes in HBV-related liver diseases. METHODS: HBV genotype was determined by the restriction fragment length polymorphism analysis in patients with chronic HBV infection in 5 cities of Fujian province. The relationship between HBV genotype and its clinical implications was studied by multinomal logistic regression and correspondence analysis. RESULTS: Of the 431 HBV DNA positive patients detected by PCR, 275 (63.8%) belonged to HBV genotype B, 100 (23.2%) to genotype C, 51 (11.8%) to genotype D and D-mixed genotype. Genotype A, E and F were not found. Multinomal logistic regression showed that genotype B was more prevalent in Quanzhou and Sanming cities than in Fuzhou (P = 0.002, P = 0.006), and genotype B appeared significantly more common in asymptomatic carriers (ASC), chronic hepatitis B (CHB) and severe hepatitis (SH). Genotype C was most prevalent in patients with liver cirrhosis (LC) (47.0%) than in those with ASC (14.5%) and SH (14.7%) (P = 0.009, P < 0.001). The positive rate of hepatitis B e antigen was higher in patients with genotype C than in those with genotype B and genotype D (56.0% vs. 52.4%, P = 0.008, and 56.0% vs. 30.8%, P = 0.051, respectively). By correspondence analysis, genotype D and D-mixed genotype seemed to be correlated with hepatocellular carcinoma (HCC). CONCLUSIONS: (1) The major popular genotypes of HBV were B, C and D in Fujian. (2) Data of our study suggested that the geographic distribution of genotype B and C might be different in some cities of Fujian. (3) Genotype B might have a tendency to lead to SH in younger patients with chronic hepatitis B and the development of LC might be associated with genotype C among the elder patients. (4) Genotype D appeared to associate with development of HCC, which called for further study to confirm.