肝细胞癌组织中HBV基因型的检测及分析

目的 了解肝细胞癌组织中HBV基因型分布状况及特点.方法 应用型特异性引物分型法和基因测序与生物信息学相结合的分型方法分析肝细胞癌组织中HBV基因型,并与HBV携带者血清中HBV基因型进行比较.结果 在63份肝细胞癌组织标本中,B、C、混合型B C和混合型B D基因型分别占20份(31.8%)、37份(58.7%)、4份(6.3%)和2份(3.2%).与HBV携带者血清相比,两者基因型构成比无显著性差异(P＞0.05).结论 中国南部地区的肝细胞癌组织中存在HBV基因型B、C、混合型B C和混合型B D,以C基因型为主,其次为B基因型.肝细胞癌组织中HBV基因型分布与当地HBV携带者基因型密切相关.     

Key role of hepatitis B virus mutation in chronic hepatitis B development to hepatocellular carcinoma

Chronic hepatitis B virus (HBV) infection is a major risk factor for hepatocellular carcinoma (HCC). The HBV mutations, which include point mutation, deletion, insertion and truncation mutation of HBV gene in 4 open reading frames (S, C, P, X), are closely associated with HCC pathogenesis. Some mutations accumulated during chronic HBV infection could be regarded as a biomarker to predict the occurrence of HCC. The detection of the mutations in clinical practice could be helpful for defining better preventive and therapeutic strategies and, moreover, predicting the progression of liver disease.     

Significance of hepatitis B virus surface antigen, hepatitis C virus expression in hepatocellular carcinoma and pericarcinomatous tissues

AIM： To investigate the correlation between hepatitis B virus surface antigen （HBsAg）, hepatitis C virus （HCV） expression in hepatocellular carcinoma （HCC）, the HAI score of the noncancerous region of the liver and the serum Alpha fetoprotein （AFP） level.
METHODS： The patterns of HBsAg and HCV in 100 cases of HCC and their surrounding liver tissues were studied on paraffin-embedded sections with immunohistochemistry, the histological status was determined by one pathologist and one surgeon simultaneously using the hepatitis activity index （HAIl score, and AFP was detected by radioimmunity. The study included 100 consecutive patients who underwent curative resection for HCC. Based on HBsAg and HCV expression, the patients were classified into 4 groups： patients positive for HBsAg （HBsAg group）, patients positive for HCV （HCV group）, patients negative for both HCV and HBsAg （NBNC group） and patients positive for both HBsAg and HCV （BC group）.
RESULTS： The BC group had significantly higher HAI scores than the other three groups. （BC 〉 HCV 〉 HBsAg 〉 NBNC）. HBV and HCV virus infection was positively correlated with HAI （rs = 0.39, P = 0.00011. The positive rate of AFP （85.7%） and the value of AFP （541.2 ng/mL） in the group with HBV and HCV co-infection were the highest among the four groups. The positive rate （53.3%） of AFP and the value of AFP （ 53.3 ng/mL） in the group with none-infection of HBV and HCV were the lowest. HBV and HCV virus infection was positively correlated with AFP（rs = 0.38, P = 0.0001）.
CONCLUSION： The AFP increase in patients with liver cancer was positively correlated with the infection of HBV and HCV. The-serum AFP elevation by the infection of HBV and HCV is one of mechanisms which lead to hepatocarcinogenesis, and the antivirus intervening treatment of hepatitis is significant for the prognosis of liver cancer. From our Spearman＇s rank correlation analysis, we can conclude that the severity of virally induced     

Isolation, characterization, and comparison of recombinant DNAs derived from genomes of human hepatitis B virus and woodchuck hepatitis virus.

The human hepatitis B virus (HBV) and the woodchuck hepatitis virus (WHV) are closely related by several criteria and belong to the same class of DNA viruses. The DNA genomes from these viruses are difficult to obtain in quantities required for biochemical analysis. We have, therefore, cloned these two DNAs in the vector lambda gtWES and subcloned into the kanamycin resistance plasmid pA01. Comparison of the recombinant DNAs with authentic viral DNAs by specific hybridization, size, and restriction enzyme analysis suggests that the recombinants contain the complete genome of each virus. The nominal size of the cloned HBV genome was 3150 base pairs, compared to 3200 base pairs for the cloned WHV genome. The small amount of nucleic acid homology previously reported between the HBV and WHV DNAs could be demonstrated between the cloned viral DNAs.     

原发性肝癌患者乙型肝炎病毒基因型与突变的地区性差异分析

目的 研究原发性肝癌患者乙型肝炎病毒(HBV)基因型、亚型和突变的地区性差异.方法 HBV阳性的原发性肝癌组织标本80例,其中广西地区20例,上海、浙江、江苏(长三角地区)60例.应用聚合酶链反应(PCR)扩增患者携带的HBV DNA序列,PCR产物直接纯化测序.用NCBI在线的软件viral genotyping tool确定HBV基因型,MEGA(Molecular Evolutionary Genetics Analysis,version 3.1)软件构建系统进化树和进行亚型分型及突变分析.结果 80例肝癌标本中,17例为B基因型(21.3%),57例为C基因型(71.3%),6例为B、C基因型混合感染(7.5%).对17例B基因型和57例C基因型的亚型分型,其中B基因型的亚型全部为B2型,C基因型的亚型有C1、C2、C5等三型,其中有12例为C1型(21.1%),44例为C2型(77.2%),1例为C5型(1.8%).广西地区的C1亚型35%(7/20)明显高于长三角地区的C1亚型8.5%(5/60),而广西地区的C2亚型20%(4120)明显低于长三角地区的C2亚型66.7%(40160).两地区HBV基因亚型分布在统计学上有显著差异.比较两地区的HBV序列还发现,广西地区B基因型CP区T1762/A1764呈现更高的突变性,有6例(100%)存在突变,而长三角地区只有2例(16.7%).结论 两地区原发性肝癌患者的HBV亚型分布和基因型B的CP区T1762/A1764突变率有显著差异.     

In situ detection of mutated hepatitis B virus in microdissected, formalin-fixed liver tissues from patients with chronic hepatitis B

BACKGROUND/AIMS: Hepatitis B virus (HBV) quasispecies have been detected in patients with chronic hepatitis B. In order to elucidate the relationship between HBV mutation and liver cell necrosis in situ, we analyzed sublobule-sized specimens microdissected from formalin-fixed paraffin-embedded liver biopsy tissues taken from patients with chronic hepatitis B. METHODS: The subjects were 20 patients with chronic hepatitis B. We extracted HBV-DNA from two sublobular regions of HBV-infected liver biopsy tissue, those with the most severe and the mildest hepatitis activity, demonstrated microscopically. The DNA coding sequence of the precore-core region of HBV was determined by amplifying the DNA by the polymerase chain reaction, followed by direct sequencing. RESULTS: In all seven patients with minimal to mild hepatitis activity, but only 4 of 13 with moderate to severe activity, the amino acid sequence of the precore-core region of HBV obtained from the region with the most severe hepatitis activity showed over 99% homology with the corresponding sequence of HBV obtained from region with the mildest hepatitis activity (p<0.05). CONCLUSION: The differences between intrahepatic HBVs observed in patients with highly active hepatitis suggest that exacerbation of hepatitis in vivo is related to the appearance of variants in the precore-core region of HBV.     

Serological markers of hepatitis B virus and hepatitis D virus infections in Greek adults with primary hepatocellular carcinoma

Summary Primary hepatocellular carcinoma (PHC) has been linked etiologically to chronic hepatitis B virus (HBV) infection by epidemiologic and molecular lines of evidence. Serologic evidence of HBV and hepatitis delta virus (HDV) infection was assessed in sera from 47 Greek patients with PHC. Radioimmunoassays for the detection of serological markers of HBV and HDV infections and molecular hybridization techniques for the detection of HBV DNA sequences were used. Serological evidence of HBV infection was found in 93.6% of PHC patients. Of the 47 patients, 20 (42.6%) were positive for HBsAg, 43 (91.5%) were positive for anti-HBc and 21 (44.7%) were positive for anti-HBs. Anti-HBe was detected in a high percentage (90%) of HBsAg positive PHC patients. Anti-HBc IgM was also detected in 90% of HBsAg positive PHC patients; in contrast, HBV DNA was detected only in 5% of them. None of the 47 patients had serological evidence of HDV infection. These data show that HBV appears to be the principal etiological agent of PHC in Greece.

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Serologische Marker für Infektionen durch Hepatitis-B- und D-Virus bei Erwachsenen mit primärem hepatozellulären Karzinom in Griechenland

Zusammenfassung Für eine ätiologische Beziehung zwischen dem primären hepatozellulären Karzinom und einer chronischen Hepatitis B-Virus-Infektion liegen epidemiologische und molekularbiologische Daten vor. In Seren von 47 griechischen Patienten mit primärem hepatozellulären Karzinom wurde nach Markern für eine Hepatitis B-Virus- und Hepatitis-D-Virus-Infektion gesucht. Serologische Marker für HBV und HDV wurden mit Radioimmunoassay bestimmt; für den Nachweis von HBV-DNA-Sequenzen wurde eine Molekular-Hybridisierungsmethode verwendet. Bei 93,6% der Patienten mit primärem hepatozellulären Karzinom wurde eine HBV-Infektion serologisch gesichert. HBsAg fand sich bei 20 der 47 Patienten (42,6%), anti-HBc bei 43 (91,5%) und anti-HBs bei 21 (44,7%). In einem hohen Prozentsatz waren die HBsAg-positiven Patienten auch anti-HBe-positiv (90%). Anti-HBc IgM wurde ebenfalls bei 90% der Fälle nachgewiesen. HBV DNA fand sich hingegen nur bei 5% der Patienten mit primärem hepatozellulären Karzinom. Serologische Marker für eine HDV-Infektion konnten bei keinem der Patienten entdeckt werden. Nach diesen Daten ist HBV offensichtlich das entscheidende ätiologische Agens für das primäre hepatozelluläre Karzinom in Griechenland.

     

乙型肝炎病毒感染的肝癌患者肝组织中乙型肝炎病毒cccDNA的检测

HBV属嗜肝DNA病毒家族,其基因组是双链松弛环状DNA(rcDNA),相对分子量为(1.6～2.0)×109,全长约为3.2 kb。在HBV的生命周期中,共价闭合环状DNA (cccDNA)是HBV的原始复制模板,对HBV的复制及感染状态的建立具有十分重要的意义。清除HBV cccDNA是目前抗HBV药物研究的一个重要目标。我们对天津市第三中心医院收治的20例HBV感染的肝癌患者肝组织(包括癌     

Simultaneous detection of hepatitis B, C, and G viral genomes by multiplex PCR method

We established a multiplex polymerase chain reaction (PCR) method for simultaneous detection of hepatitis B, C, and G viral genomes. The levels of concordance with the data obtained by conventional single PCR method were 100% for single infection, 98 to 100% for double infections, and 92% for triple infections. This method is not only suited to rapid, large-scale epidemiological screening and clinical diagnosis of those virus infections occurring alone or in combination, but is also time- and cost-effective.     

Frequent integration of precore/core mutants of hepatitis B virus in human hepatocellular carcinoma tissues

The development of hepatitis B virus (HBV)-associated hepatocellular carcinoma (HCC) frequently follows persistent HBV infection and may arise in individuals who are hepatitis B e antigen (HBeAg) negative, indicating the possible presence of precore/core mutants. It is unclear whether precore/core mutants are associated with tumour development or are selected for after chromosomal integration of the wild-type viral DNA. We studied the status and sequence variation of the precore/core region of HBV in 56 patients with HBV-associated HCC and in various corresponding non-tumour tissues by Southern blot analysis, polymerase chain reaction and direct sequencing. Southern blot showed that integrated HBV DNA existed in 43 of 56 HCC tissues. Sequence analysis revealed mutations in 65% of the HCC (26/40) and 45% (14/31) of the corresponding non-tumour tissues. The mutation at nucleotide (nt) 1896, known to prevent HBeAg synthesis, was detected in 40% (16/40) of the tumours and in 35.4% (11/31) of the non-tumour tissues. Other mutations were found at nt 1899 (eight of 40 in HCC; three of 31 in non-tumour tissues), nt 1898 (seven of 40 in HCC; two of 31 in non-tumour tissues), nt 1912 (seven of 40 in HCC; none of 31 in non-tumour tissues) and nt 1886 (three of 40 in HCC; none of 31 in non-tumour tissues). To determine whether this finding merely reflected the prevalence of such mutants in this geographical region, HBV DNA from the sera of patients (also in this region) with acute and chronic hepatitis were sequenced. The nt 1896 mutant was found in 5.6% (one of 18) of patients with acute hepatitis B and in 22.8% (nine of 35) of patients with chronic hepatitis B. However, the nt 1898 mutation was not found in any of these sera. The precore/core mutant was observed with increasing frequency from acute hepatitis to chronic hepatitis, non-tumour and HCC, and this difference in frequency was significant between HCC and acute hepatitis B groups (P < 0.01), suggesting that the precore/core mutant or hepatocytes harbouring this mutant may be under immune selection and that such mutations may facilitate integration and subsequent tumour development.     

Integration of hepatitis B virus DNA into cells of six established human hepatocellular carcinoma cell lines.

The authors successfully established 5 hepatocellular carcinoma cell lines, JHH-1, 2, 4, 5 and 6, derived from hepatitis B surface antigen seronegative patients and one line. JHH-7, from a patient considered to be a hepatitis B virus carrier. In the culture media of any of the JHH cell lines, including JHH-7, hepatitis B surface antigen was not detected by radioimmunoassay. However, in JHH-7, integration of hepatitis B virus DNA was confirmed at two sites on the chromosomes of this line by Southern blot hybridization. In contrast, in other JHH cell lines derived from hepatitis B surface antigen seronegative patients, integration of hepatitis B virus DNA into the chromosomes of cells was not detected. These cell lines will be useful in the investigation of hepatocellular carcinoma development, especially for research into non-A/non-B hepatitis viruses.     

Establishment and characterization of four human hepatocellular carcinoma cell lines containing hepatitis B virus DNA

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Analysis of cost-effectiveness of different strategies for hepatocellular carcinoma screening in hepatitis B virus carriers

A mathematical model was used to calculate the efficacy of screening to detect hepatocellular carcinoma at a resectable stage in hepatitis B virus carriers. Data relating to tumour incidence, efficacy of screening tests and tumour growth times were obtained from a literature review. Various tests were costed according to charges currently prevailing at the authors' institution. The cost per early tumour detected is inversely proportional to tumour incidence. It is relatively low for populations with high incidences of hepatocellular carcinoma for example, male carriers over the age of 30. Both the costs and the proportions of early tumour detected increase with increasing frequency of screening. However, the use of ultrasonography at 10 monthly intervals or both ultrasonography and alpha-fetoprotein estimation at yearly intervals will detect 90% of tumours early at a cost of S$20,000 (US$11,800) per early tumour detected. The results would be significantly altered if tumour growth times were markedly different from those reported in the literature.     

肝细胞癌和癌旁组织中乙型肝炎病毒DNA整合的克隆性

目前肝细胞癌(HCC)的诊断从临床诊断发展到亚临床诊断。许多并无症状及体征的亚临床期患者亦可获得明确的诊断。但一些体积较小的如直径小于2 cm的肝内瘤样病变与甲胎蛋白(AFP)阴性小HCC,因病灶过小,肝穿刺活体组织检查也不易获得准确诊断。     

Genotypes, mutations, and viral load of hepatitis B virus and the risk of hepatocellular carcinoma: HBV properties and hepatocarcinogenesis

Chronic infection with hepatitis B virus (HBV) is the major risk factor for hepatocellular carcinoma (HCC) worldwide. Ten HBV genotypes (A-J) have been discovered so far. Genotypes B and C are endemic in East and Southeast Asia. Genotype C HBV is associated with increased risks of cirrhosis and HCC. Genotype B (B2) is associated with the development of HCC in non-cirrhotic patients younger than 50 years and with relapse of HCC after surgical treatment. It is also associated with earlier hepatitis B e antigen seroconversion than genotype C. High HBV load is independently associated with the occurrence and post-treatment recurrence of HCC. Different genotypes have distinct patterns of mutations. Viral mutations in the core promoter region and in the preS region are frequently found to be significantly associated with an increased risk of HCC. These mutations often occur before the onset of HCC and accumulate during the progression of chronic HBV infection. Multiple such mutations are more frequent in patients with HCC and are specific for HCC. HBV subgenotypes, viral mutations, and viral load can be used for the prediction of HCC. Early identification of HBV-infected individuals who will eventually develop HCC will help to develop active prophylactic protocols to reduce or delay the occurrence of HCC.