Differential gene expression between asymptomatic HBV carriers and normal adults

BACKGROUND:There are more than 100 million asymptomatic HBV carriers(ASCs)in China and they are at a high risk of developing liver disease,which creates a serious health problem.But more than 90%of normal adults clear virus from primary HBV infection,so the difference of gene expression between ASCs and normal adults determines the differential outcomes.To identify differentially expressed genes in ASCs compared to normal adults,we used suppression subtractive hybridization to compare gene expression. METHO...     

Histological findings in asymptomatic hepatitis C virus carriers

There is controversy about clinical management of individuals who persistently have hepatitis C virus antibodies (HCVAb) but who have no symptoms or signs of liver disease. Liver biopsy samples were taken from 15 individuals, all of whom had normal alanine aminotransferase (ALT) levels, to determine the prevalence of liver disease and whether HCVAb and HCV-RNA correlate with histological findings. Eleven patients with hepatitis C viremia had histological evidence of chronic hepatitis on biopsy. On the other hand, four HCV-RNA-negative individuals had almost normal liver histology. These findings indicate that serum HCV-RNA is a sensitive and specific marker of liver disease in HCVAb-positive subjects, independent of ALT levels. Furthermore, these results suggest that there are very few histologically healthy carriers of HCV among HCV-RNA-positive individuals.     

ALT正常的HBV慢性携带者肝组织病理结果分析

了解ALT正常的HBV慢性携带者（ASC）的肝组织病理改变状况,探讨其临床意义及其与HBVDNA、HBeAg的关系。对32例ALT正常的HBV慢性携带者行快速经皮肝穿刺术取肝组织,研究肝组织炎症活动度及纤维化程度分级分期;ELISA法检测血清HBVM,PCR法检测血清HBVDNA。结果没有真正的健康ASC（病理状态为G0S0）,32例ASC中,G1S0有15例,G1S1有13例,G2S1有4例;肝组织学的炎症活动及纤维化改变程度HBVDNA阳性组明显重于HBVDNA阴性组,男、女之间、HBeAg定性检测及HBVDNA水平的比较,无明显差异。     

血清乙型肝炎病毒DNA定量在慢性乙型肝炎病毒感染的临床意义

目的:测定慢性HBV感染不同状态时血清HBV-DNA水平,阐明其在判断病情和指导治疗中的价值。方法:共90例慢性HBV感染患者接受研究,共中HBeAg阳性无症状携带者(ASC)15例,HBeAg阳性慢性肝炎(CHB)17例,HBeAg阴性CHB14例,HBeAg阴性ASC16例;另有28例HBeAg阳性CHB接受干扰素治疗。血清HBV-DNA浓度测定应用AG-9600Amplisensor荧光PCR定量系统,测定范围定为10~(3.00-9.50)copies/ml。结果:血清HBV-DNA在HBeAg阳性ASC病例最高,达10~(8.46±0.71)copies/ml,其次依次为HBeAg阳性CHB(10~(7.24±0.54) cooies/ml)、HBeAg阴性CHB(10~(6.04±0.69) copies/ml),HBeAg阴性ASC者最低,为10~(3.80±0.71)copies/ml。4组病例相互之间差异在统计学上均有显著意义(P<0.01)。28例BHeAg阳性CHB患者接受干扰素治疗,治疗结束时呈完全应答(CR)者13例,无应答(NR)15例。对13例CR患者继续随访6个月,其中4例血清ALT再升高(复燃)。血清HBV-DNA水平在治疗前,CR不伴ALT复燃组HBV-DNA为10~(3.44±0.43)copies/ml,明显低于CR伴ALT复燃组(10~(6.84±0.51))(P<0.01)和NR组(10~(7.18±0.66))(P<0.01)。结论:测定血清HBV-DNA水平有助于鉴别慢性HBV感染的不同状态;在HBeAg阳性CHB病例,干扰素治疗结束时,检测HBV-DNA水平对于判断疗效有指导价值,HBV-DNA低于104copies/ml往往能取得持久疗效。     

慢性乙型肝炎患者和无症状病毒携带者外周血B淋巴细胞亚群的变化

细胞免疫反应对乙型肝炎病毒(HBV)的清除作用已得到充分的研究和重视,宿主对HBV的免疫应答,需要T、B细胞间的密切合作,而B细胞在宿主抗HBV免疫应答中的作用研     

慢性HBV携带者肝组织Fas和Fas配体表达变化及其意义

目的：观察慢性HBV携带者（chronic asymptomatic HBV carrier,ASC）肝组织Fas和Fas配体（FasL）的表达和血清可溶性Fas（sFas）水平的变化。方法对120例ASC行肝穿刺,采用免疫组织化学法检测肝组织Fas和FasL表达,采用ELISA法检测血清sFas水平。结果120例ASC肝组织完全正常者仅占11%,轻度肝炎占59%,而中、重度肝炎占30%;表现正常的肝组织无Fas和FasL表达,轻度肝炎肝组织多无表达或仅限于界面炎症区的肝细胞及淋巴细胞阳性表达,而中、重度肝炎肝组织Fas和FasL多为阳性,Fas强阳性率分别达34.8%和69.2%,FasL强阳性率分别达30.4%和53.8%,均明显高于正常组和轻度炎症组（P〈0.05）,同时中、重度肝炎组间也存在显著性差异（P〈0.05）,其分布除界面炎症区外,肝小叶中也弥漫分布;肝组织表现正常的ASC血清sFas水平为（1.68±0.33） ng/L,而轻、中、重度肝炎患者则分别为（2.58±0.31）ng/L、（3.94±0.21）ng/L和（5.94±0.26）ng/L,均较正常组显著升高（F=218.01,P〈0.01）,各组间sFas水平也均具有统计学差异（P〈0.01）。结论 Fas和FasL介导的肝细胞凋亡在慢性HBV携带者肝组织病变中可能起到了重要作用。     

黄石地区慢性无症状乙型肝炎病毒携带者的基因型分布

目的：了解湖北黄石地区慢性无症状乙型肝炎病毒（HBV）携带者HBV基因型的分布，及其与病毒复制水平、HBeAg表达的相关性。方法：选择黄石地区168例慢性无症状HBV携带者作为研究对象，HBV基因型采用PCR微板核酸杂交．ELISA方法检测；血清HBVDNA复制水平采用荧光定量PCR检测；HBV—M采用ELISA法检测。结果：168例慢性无症状HBV携带者中HBVDNA阳性者为114例（阳性率为67．9％），其基因型分布为B、C、D型以及这3种基因型组成的混合型，而未发现A、E、F基因型。其中以B型、C型为主，所占比例为62．6％和36．8％，D型及混合型比例均为5．3％。C基因型患者中，HBV DNA呈现高水平复制（10^7～10^8 Copies／ml）的患者比例为26．2％（11／42），B基因型为13．3％（8／60）（P〈0．05）。C基因型患者血清抗-HBe阳性率（40．5％）显著高于B基因型（15．0％）（P〈0．01）。结论：黄石地区存在HBV的B、C、D基因型，以及由它们组成的混合基因型；B基因型为优势基因型；C基因型与HBV高复制水平，以及基因变异相关。     

Clinical, biochemical, immunological and virological profiles of, and differential diagnosis between, patients with acute hepatitis B and chronic hepatitis B with acute flare

Background and Aim: In areas with high or intermediate endemicity for chronic hepatitis B virus (HBV) infection, it is difficult to distinguish acute hepatitis B (AHB) from chronic hepatitis B with an acute flare (CHB‐AF) in patients whose prior history of HBV infection has been unknown. The present study aimed to screen laboratory parameters other than immunoglobulin M antibody to hepatitis B core antigen (IgM anti‐HBc) to discriminate between the two conditions. Methods: A retrospective and prospective study was conducted in patients first presenting clinically as HBV‐related acute hepatitis to sort out acute self‐limited hepatitis B (ASL‐HB). Then, clinical and laboratory profiles were compared between patients with ASL‐HB and CHB‐AF. Parameters closely associated with ASL‐HB were chosen to evaluate sensitivity, specificity, accuracy, positive predictive values and negative predictive values for diagnosing AHB. Results: There were significant differences between patients with ASL‐HB and CHB‐AF in relation to clinical and laboratory aspects, with many outstanding differences in levels of serum HBV‐DNA, hepatitis B e antigen (HBeAg) and alpha‐fetoprotein (AFP) as well as IgM anti‐HBc. In particular, there was a greater difference between the two groups in low levels of HBeAg (ratio of the optical density of the sample to the cut‐off value [S/CO] <20) than in negativity for HBeAg (42.7% and 13.5% vs 49.3% and 45.9%). 1:10 000 IgM anti‐HBc had a sensitivity and specificity of 96.2% and 93.1%, respectively, for predicting ASL‐HB. Combining it with AFP, HBeAg or HBV‐DNA could improve diagnostic power. A combination of IgM anti‐HBc, HBV‐DNA and HBeAg had a predictive value of 98.9% and a negative predictive value of 100.0%, similar to that of a combination of IgM anti‐HBc and HBV‐DNA. Adding AFP to the combinations of IgM anti‐HBc and HBV‐DNA or HBeAg could further heighten the positive predictive value. The positive predictive value and negative predictive value of the combination of IgM anti‐HBc, HBV‐DNA and AFP were both 100.0%. Conclusions: (i) There are significant differences with respect to clinical, biochemical, immunological and virological aspects between ASL‐HB and CHB‐AF. (ii) Of several diagnostic combinations, IgM anti‐HBc jointing HBV‐DNA is most effective and most practicable in distinguishing ASL‐HB from CHB‐AF. (iii) A low HBeAg level is more useful than negative HBeAg in differential diagnosis between ASL‐HB and CHB‐AF. (iv) In those patients with a high level of IgM anti‐HBc, serum AFP level >10× upper reference limit could rule out a probability of ASL‐HB.     

HBV在慢性乙型肝炎患者肝细胞染色体上整合情况的临床分析

采用荧光原位杂交(FISH)技术检测慢性乙型肝炎患者肝细胞染色体,明确是否存在HBV的整合及整合情况。选择我院慢性乙型肝炎患者共16例,制备其肝细胞染色体标本,以地高辛标记的HBV探针进行原位杂交。16例患者中,有5例患者的肝细胞分裂期染色体上可观察到绿色荧光信号,占31.25%,HBV呈低频率整合(1.00%~1.50%),整合位点呈随机分布。通过研究发现,应用FISH技术可检测肝细胞染色体上整合型HBV。慢性乙型肝炎患者肝细胞染色体上存在整合型HBV,使HBV感染可能发生成为一种遗传性传染性疾病,并成为肝癌高发的重要危险因素。     

难治性慢性乙型肝炎

"难治性慢性乙型肝炎"的定义:符合慢性乙型肝炎的诊断标准,因各种原因/因素导致在现有指南或建议治疗方案指导下,使用了包括核苷(酸)类似物和(或)干扰素在内的抗HBV药物治疗失败或疗效不佳、或不规范抗病毒治疗所致、或已有循证医学依据证实疗效不佳的慢性乙型肝炎.难治性慢性乙型肝炎概念的提出,有利于乙型肝炎患者接受临床规范化...     

慢性乙型肝炎病毒感染者肝组织HBcAg表达与临床及病理特征的关系

目的探讨慢性HBV感染者肝组织HBcAg表达及其在亚细胞结构的分布与血清HBeAg表达、HBV DNA水平及肝组织病理学损害的关系。方法对371例慢性HBV感染者进行肝穿刺活检,检测肝组织HBcAg、血清HBV标志物、血清ALT及血清中的HBV DNA水平。比较HBcAg阴性与HBcAg表达为核型、浆型、浆核型的病例血清HBeAg阳性率、HBV DNA水平与肝组织病理学损害的关系。同时观察血清HBeAg阳性组及阴性组,肝细胞HBcAg不同表达形式在不同年龄阶段的分布特点。结果肝组织HBcAg阴性组血清HBeAg阳性率为33.1%,比HBcAg阳性各组均低(核型组68.7%;浆型组62.3%;浆核型组84.5%),炎症分级G≥2的患者比例为21.5%,低于HBcAg阳性各组(核型34.3%;浆型67.7%;浆核型69.1%),P<0.01,差异有统计学意义。其中浆型组及浆核型组G≥2的患者比例高于核型组,P<0.01,差异有统计学意义。血清HBV DNA水平在核型组高于其他各组,P<0.05,差异有统计学意义。血清HBeAg阳性组中,年龄≤20岁的HBcAg肝细胞表达为核型的比例为61.5%,高于年龄为20～39岁的11.5%及年龄≥40岁的12.3%,随年龄增加浆型及浆核型表达的比例增加,在三组分别为23.1%/7.7%、26.4%/30.8%、28.4%/45.4%,差异有统计学意义(χ2=53.74,P<0.01)。血清HBeAg阴性组中,肝组织HBcAg阴性的在各年龄组均占大部分(68.1%、61.5%、40.4%)。随年龄增加浆型及浆核型表达的比例增加,在三组分别为4.6%/4.6%、19.3%/7.7%、26.9%/20.4%,差异无统计学意义(χ2=8.94,P>0.05)。结论慢性乙型肝炎患者肝组织HBcAg表达与血清HBeAg表达有关。浆型及浆核型HBcAg表达常伴随明显的肝组织炎症。HBcAg表达形式在不同年龄阶段具有不同特点,与其所处自然史阶段有关。     

Clinical outcomes of chronic hepatitis B patients with persistently detectable serum hepatitis B virus DNA during lamivudine therapy

BACKGROUND AND AIM: A small proportion of chronic hepatitis B patients have persistently detectable serum hepatitis B virus (HBV) DNA despite lamivudine therapy. The incidence and clinical outcomes of patients who persistently have detectable serum HBV-DNA during lamivudine therapy was investigated. METHOD: We enrolled 221 chronic hepatitis B patients who underwent lamivudine therapy for more than 6 months. Among them, 180 were HBeAg positive. Serum HBV-DNA, HBeAg, anti-HBe and alanine aminotransferase (ALT) levels were serially monitored. The study groups were defined, using a hybridization assay, as patients with reductions in serum HBV-DNA below the detectable level (group I) or patients with persistently detectable serum HBV-DNA (group II) during the initial 6 months of lamivudine therapy. RESULTS: The incidence of patients who had persistently detectable HBV-DNA was 7.7%. After the first year, the rates of viral breakthrough, HBeAg loss and serum ALT normalization of group I versus group II were 21% versus 63%, 38% versus 0%, and 71% versus 28%, respectively (P < 0.001). The log(10) reduction of serum HBV-DNA at 6 months was -4.58 log(10) for group I and -1.97 log(10) for group II (P < 0.001, bDNA assay). There were no pretreatment lamivudine-resistant mutants in group II. CONCLUSION: Lamivudine had little effect on serum HBV-DNA suppression, viral breakthrough suppression and rate of HBeAg loss and ALT normalization in chronic hepatitis B patients with persistently detectable serum HBV-DNA during the initial 6 months of therapy. Early termination of lamivudine therapy is advocated for these patients.     

慢性乙肝病毒携带者中医证候分布规律调查及病机探讨

目的:研究慢性乙肝病毒(HBV)携带者的中医证候分布规律及病机.方法:选择3 000例慢性HBV携带者,分别填写中医证候调查表,进行辨证分析.结果:慢性HBV携带者分为10种证型,10种证型及出现频数所占百分比分别为:肾虚型(31.90％)、脾虚型(20.41％)、肝气郁结型(16.92％)、肝胃不和型(8.60％)、肝胆湿热型(7.37％)、肝阴虚型(6.59％)、湿热中阻型(5.96％)、湿困中焦型(4.58％)、肝血虚型(4.05％)、血瘀阻络型(1.55％).肾虚型又分为肾阳虚型、肾阴虚型、肾气虚型和肾精不足型,分别占总频次的9.45％、9.38％、12.30％、0.08％,脾虚型又分为脾气虚型和脾阳虚型,分别占总频次的16.28％和4.12％.兼证以肝胆湿热和湿热中阻为主.结论:慢性HBV携带者的最主要中医证型是肾虚型和脾虚型,其病机为疫毒内伏,脾肾亏虚,正气不足,无力鼓邪外出.     

Hepatocyte hepatitis B surface antigen expression in chronic hepatitis B virus carriers in Singapore: Correlation with viral replication and liver pathology

The hepatocyte hepatitis B surface antigen (HBsAg) expression in 149 liver biopsies from 124 chronic hepatitis B virus (HBV) carriers was correlated with serum HBV DNA status and histologic activity. Hepatocyte HBsAg was stained by the peroxidase-antiperoxidase method and serum HBV DNA was determined by dot blot hybridization. Sixty-five biopsies (44%) showed minimal changes (MC), 82 biopsies (55%) showed chronic liver disease (CLD) and 2 biopsies (1%) showed hepatocellular carcinoma. Hepatocyte HBsAg was found in 144 biopsies (97%). It was present in the cytoplasm of 141 specimens (95%) and/or plasma membrane of 48 specimens (32%). Approximately half (45%) of the cytoplasmic HBsAg-positive biopsies showed discrete distribution, while the other half (55%) were grouped. Fifty-five per cent (77 of 141) of cytoplasmic HbsAg-positive biopsies had CLD, while 44% (62 of 141) showed MC. There was no relationship between the presence of cytoplasmic HBsAg or its topographic distribution with disease activity. Membrane HBsAg distribution was similar for both groups of patients (MC vs CLD: 25 of 65 (38%) vs 23 of 82 (28%); P = NS). Serum HBV DNA was detected in 98 patients (66%) and was seen mostly in association with CLD (CLD vs MC: 61% vs 39%, P less than 0.001). It was also detected more often in the sera of patients with membrane HBsAg than in those with cytoplasmic HBsAg staining (41 of 48 (85%) vs 97 of 141 (67%); P less than 0.02). However, discrete distribution of cytoplasmic HBsAg was associated with positive serum HBV DNA when compared with grouped distribution (52 of 63 (83%) vs 43 of 78 vs (55%); P less than 0.005).     

恩替卡韦治疗慢性乙型肝炎病毒携带者近期疗效观察

目的 观察恩替卡韦治疗慢性HBV携带者的近期疗效与安全陛,探讨慢性HBV携带者抗病毒治疗的临床意义. 方法 慢性HBV携带者47例,慢性乙型肝炎患者46例,诊断均符合“慢性乙型肝炎防治指南(2010年版)”.两组患者均给予恩替卡韦分散片0.5 mg/d口服治疗,观察两组患者治疗第4、12、24、48周血清学应答率、生物化学应答率与突破率的差异,并观察药物相关不良事件发生率.数据均使用SPSS17.0统计分析软件进行,分别采用t检验和x2检验.结果 第4、12、24、48周完全病毒学应答率:慢性HBV携带者组分别为14.9％、51.1％、76.6％和97.9％;慢性乙型肝炎患者组分别为,17.4％、63.0％、89.1％和100.0％,两组间各时间点比较,差异均无统计学意义.第4、12、24、48周部分病毒学应答率:慢性HBV携带者组分别为42.6％、57.4％、85.0％和100.0％;慢性乙型肝炎患者组分别为47.8％、65.2％、89.1％和100.0％,两组间各时间点比较,差异均无统计学意义.第4、12、24、48周HBeAg阴转率:慢性HBV携带者组分别为0、2.1％、4.3％和8.5％;慢性乙型肝炎患者组分别为4.4％、8.7％、13.0％和21.7％,两组间各时间点比较,差异均无统计学意义.第4、12、24、48周HBeAg血清学转换率:慢陛HBV携带者组分别为0、0、2.1％和6.4％;慢性乙型肝炎患者组分别为0、4.4％、10.9％和17.4％,两组间各时间点比较,差异均无统计学意义.HBsAg阴转率与血清学转换率,两组各观察时段均为0.慢性乙型肝炎患者组第4、12、24、48周ALT复常率分别为26.1％、65.2％、91.3％和97.8％.两组患者均无病毒学突破和生物化学突破病例.两组患者均未观察到肾毒性、骨髓抑制、横纹肌溶解或其他药物相关不良事件.结论 采用恩替卡韦分散片治疗慢性HBV携带者近期疗效好、安全.     

慢性乙型肝炎患者血清磷脂酰肌醇-4-磷酸酶的表达与HBV DNA载量的相关性

目的探讨慢性乙型肝炎患者血清磷脂酰肌醇-4-磷酸酶(PI4KA)表达与HBV载量的关系。方法收集2012年6月-2013年4月在青岛市立医院就诊的180例慢性乙型肝炎患者的血清,利用荧光定量PCR检测其HBV DNA的载量,根据其HBV DNA载量的高低,分为3组,每组60例:高病毒载量组(HBV DNA1×107拷贝/ml)、中病毒载量组(1×105拷贝/ml≤HBV DNA≤1×107拷贝/ml)及低病毒载量组(HBV DNA1×105拷贝/ml),同时以60名健康人作对照。采用ELISA法,检测各组外周血清中的PI4KA的浓度。多组间血清HBV DNA定量的比较采用单因素方差分析,进一步两两比较采用LSD-t检验。PI4KA水平与HBV DNA载量之间的相关性分析采用Spearman检验。结果健康人血清PI4KA的浓度为(2.29±0.75)ng/ml;低、中、高病毒载量组血清PI4KA的浓度分别为(2.73±0.71)、(3.52±0.78)及(4.72±0.77)ng/ml。慢性乙型肝炎患者不同病毒载量组与健康对照组间血清PI4KA的浓度差异有统计学意义(F=119.958,P0.01),并且不同病毒载量组都显著高于对照组。随着HBV DNA载量的升高,PI4KA的浓度增加,两者呈正相关(r=0.758,P0.01)。结论慢性乙型肝炎患者血清PI4KA的浓度与HBV DNA载量密切相关,这一结果提示PI4KA可能在HBV DNA的复制中起到重要作用。     

HBsAg阴性的慢性乙型和丙型重叠感染肝炎患者临床研究

为探讨HBsAg阴性的慢性乙型重叠丙型肝炎患者HBV -DNA水平及临床特征 ,采用PCR -微板核酸杂交 -ELISA法对 2 0 3例HBVM一项 /一项以上阳性的慢性丙型肝炎患者进行HBV -DNA定量及HCV -RNA基因分型检测 ,并分析患者性别、年龄以及肝功能等临床特征。HBsAg阴性及HBsAg阳性慢性丙型肝炎患者在性别、年龄分布上无差异 ;但血清ALT及总胆红素水平在HBsAg阳性者较高。Ⅱ / 1b型HCV感染在HBsAg阴性者中的比例高于HBsAg阳性者 (P <0 0 5 )。HBsAg阴性慢性丙肝患者HBV -DNA阳性率及HBV水平均低于HBsAg阳性患者。HBsAg阴性的慢性丙肝患者中 ,抗HBc单独阳性者HBV -DNA阳性率最高 ,但HBV -DNA水平无显著性差异。Ⅱ /1b型HCV感染在HBV -DNA阴性患者中的出现频率较高 ,与HBV -DNA阳性患者相比差异有显著性。因此 ,临床上对于那些肝功能损害严重 ,同时有抗HBc阳性或Ⅱ / 1b型HCV感染 ,尤其是HCV -RNA阴性而肝功能仍有持续损害的患者要及时行HBV -DNA检测 ,以除外HBV活动的可能     

经病理诊断的慢性乙型肝炎病毒携带者与慢性肝炎的临床分析

目的 比较病理学诊断为慢性HBV携带者与慢性肝炎患者的临床资料,为不同ALT水平的慢性HBV感染者的处理提供病理学依据.方法 对292例慢性HBV感染者进行肝活组织检查,按病理学诊断符合慢性HBV携带者标准(G0～G1且S0～S1)与慢性肝炎标准[G＞1和(或)S＞1]分为携带组和肝炎组,比较不同年龄分层及ALT水平分层与病理诊断的关系,同时比较其他可能与病理诊断相关的临床、生物化学及影像学指标,Logistic回归方程(后退法,极大似然法)进行多因素分析,确定病理学符合慢性HBV携带者诊断的独立影响因素.结果 292例患者中,病理诊断为慢性HBV携带者有140例,占47.9％;慢性肝炎152例,占52.1％.HBV携带组与慢性肝炎组在≤35岁与36～40岁、＞40岁比较,差异有统计学意义(x2=3.936,8.534;P=0.047,0.003); ALT水平在＜0.5×正常值上限(ULN)、(0.5～1.0)×ULN、(1.1～1.5)×ULN、(1.6～2.0)×ULN、＞2.0×ULN间比较差异有统计学意义(x2=55.314,P＜0.01),但ALT在(1.1～1.5)×ULN与＞2.0×ULN比较,差异无统计学意义(x2=3.810,P=0.051).多因素分析显示,病程、饮酒史、ALT分层、HBV DNA水平及超声检查肝表面是否光滑是病理学符合慢性HBV携带者诊断的独立影响因素(OR=0.995、0.224、0.516、1.308、0.270,P=0.005、0.007、0.000、0.025、0.001).结论 年龄35岁以上且ALT水平介于(1～2)×ULN的患者行肝活组织检查的临床意义更大.     

Distribution of hepatitis B virus genotypes among patients with chronic infection.

Hepatitis B virus (HBV) can be classified into at least eight genotypes, A-H. We evaluated the distribution HBV genotypes among patients with chronic infection. METHODS: We consecutively evaluated adult patients with chronic HBV infection from Salvador, Brazil. Patients were classified according to HBV infection chronic phases based on HBV-DNA levels and presence of serum HBV markers. HBV-DNA was qualitatively and quantitatively detected in serum by polymerised chain reaction (PCR). Isolates were genotyped by comparison of amino acid mutations and phylogenetic analysis. RESULTS: One-hundred and fourteen patients were evaluated. HBV-DNA was positive in 96 samples. HBV genotype was done in 76. Mean age was 36 +/- 11.3. In 61 of 76 cases subjects were classified as inactive HBsAg carriers. Their mean HBV serum level was 1760 copies/ml and 53 of 61 were infected with HBV genotype A, seven with HBV genotype F and one with genotype B. Twelve of the 76 patients had detectable hepatitis B e-antigen (HBeAg) in serum. Ten were infected with HBV genotype A and two with genotype F; most had increased alanine aminotransferase and high HBV-DNA levels. Three patients were in the immunotolerant phase, two were infected with HBV genotype A and one with genotype F. HBV subtyping showed subtypes adw2 and adw4. CONCLUSIONS: HBV genotype A adw2 and genotype F adw4 were the most prevalent isolates found. We could not find differences in genotype distribution according to HBV clinical phases and DNA levels. We did not detect HBV genotype D in contrast to a previous study in our center with acute hepatitis B. All inactive HBsAg carriers had low HBV-DNA levels.