天津地区家族聚集性慢性乙型肝炎病毒感染者病毒载量及组织病变与基因型的关系

目的探讨天津地区家族聚集性HBV感染患者基因型特征与病毒载量及肝组织病理的关系。方法随机采集临床确诊家族聚集性的慢性HBV表面抗原携带者(ASC)35例和轻型CHB患者65例。分别进行HBV基因分型、HBV DNA载量、肝组织病理学检测。结果HBV基因型显示:B型7例,HBV DNA主要为低载量(57.14%),病理损害程度较轻。BC混合型11例,HBV DNA以低、中载量为主(45.45%、36.36%),病理损害多为轻至中度≤G2 10例(90.91%),≤S2 9例(81.82%)。C型82例,其中ASC 29例,HBV DNA以高载量为主(72.41%),均有不同程度的病理损伤(100%);CHB 53例,HBV DNA主要为中、高载量(39.62%,49.06%),病理损害≥G2者38例(71.70%),≥S2者25例(47.17%)。结论天津地区家族聚集性ASC和CHB以基因C型为主、病毒载量高、肝组织病理损伤较严重,为乙型肝炎预后不良的主要因素;家族聚集性ASC不仅存在HBV病毒高载量,而且均有不同程度的肝脏病理损伤,临床可视肝组织病理结果酌情抗病毒治疗;肝组织病理学检查作为ASC和CHB患者治疗前的常规检测手段,为规范CHB的抗病毒治疗提供可靠依据。

The relationships among HBV genotypes, HBV DNA levels and histopathological features in the livers of familial grouped hepatitis B patients in the Tianjin area

OBJECTIVE: To analyse the relationships among HBV genotypes, HBV DNA levels and histopathological features of the livers of familial grouped hepatitis B patients in the Tianjin area. METHODS: One hundred familial grouped hepatitis B (CHB) patients were enrolled in this study. Thirty-five of the 100 patients were chronic asymptomatic HBsAg carriers (ASC) and 65/100 were mild CHB patients. Their HBV genotypes and HBV-DNA levels were detected and liver biopsies were performed for analyzing the pathological features. RESULTS: Seven patients were of HBV genotype B (7%), and most of them had a HBV DNA level in the middle 10(3-5) copies/ml (57.14%). The histopathological features of the livers were of different degrees of injury. Eleven patients HBV was of genotype BC (11%); their HBV DNA levels were from 10(3-5) copies/ml (45.45%) to 10(6-7)copies/ml (36.36%). Their liver pathology showed slight or severe injuries (< or = G2 90.91%, < or = S(2) 81.82%). Eighty-two patients HBV was of genotype C (82%), and among the 82, 29 were ASC and 53 were CHB. Among the ASC, most of them had a high HBV DNA level (72.41%), and all of them had different degrees of liver injury. Among the CHB, their HBV DNA levels were 10(6-7) copies/ml (39.62%) and more than or equal 10(8) copies/ml (49.06%). The liver histopathological features were > or = G(2) in 38 patients (71.70%), and > or = S(2) in 25 patients (47.17%). CONCLUSIONS: (1) In the majority, HBV of the family gathered hepatitis B patients living in Tianjin is of genotype C and they have a high HBV-DNA level and severe liver pathological injuries. These features of the family gathered hepatitis B patients are the main factors causing the unfavorable prognosis of the patients. (2) There is inflammation of different degrees in the livers and high HBV DNA levels in all the family gathered ASC patients. Antiviral therapy should be planned according to the pathological features in patients livers. (3) Liver biopsies should be performed routinely before their antiviral therapy.