海南乙肝患者HBV基因型分布及临床指标的相关性

目的 研究海南地区乙型肝炎病毒（hepatitis B virus,HBV）的基因型在乙肝携带者、肝硬化和肝癌患者中的分布状态,以及这些基因型与临床相关指标如肝功能转氨酶谱、腺苷脱氨酶（adenosine deaminase ,ADA）、α-L-岩藻糖苷酶（α-L-fucosidase, AFU）、甲胎蛋白（alpha-fetoprotein, AFP）之间的关系和临床意义。方法 利用巢式PCR方法对海南省第三人民医院163例就诊有HBV感染的携带者、肝硬化和肝癌临床患者的血清标本进行HBV DNA扩增,并用聚合酶链反应–限制性片段长度多态性法鉴定HBV基因型;同时收集患者的民族、临床资料和实验室检查结果等资料,利用SPSS统计软件进行t检验、卡方检验、Logistics回归分析等统计分析。结果 总共检测了207例乙型肝炎病毒感染患者的血清标本,其中44例未获得有效的基因型数据。在检测出具体基因型的163例HBV感染者中,HBV B基因型25例占15.3%,HBV C基因型132例占81.0%,HBV B/C混合型6例占3.7%。HBV基因型之间的患者年龄、性别、民族、疾病状态、乙型肝炎e抗原（HBeAg）阳性率、HBV DNA水平差异并无统计学意义。HBV C型感染者天冬氨酸转移酶（aspartic transferase,AST）水平高于HBV B型感染者。所有HBV C基因型患者中,肝硬化及肝癌患者占的比例最高。患者ADA数值与HBV基因型的状态有明显关联,ADA值升高的患者,感染HBV B型病毒的可能性增加（P=0.044）。结论 海南地区乙型肝炎患者HBV基因型以 C型为主,HBV C型感染者的肝脏功能更容易受损,ADA数值较低,临床上易向肝硬化及肝癌进展。

HBV genotype distribution and clinical characters in patients with hepatitis B in Hainan

Objective To study the genotype distribution of hepatitis B virus (HBV) in patients with hepatitis B, liver cirrhosis and hepatocellular carcinoma (HCC) in Hainan Province, and to investigate the relationship between these genotypes and the clinical characters such as hepatic transaminase, adenosine deaminase (ADA), α-L-fucosidase (AFU) and alpha-fetoprotein (AFP).Methods The nested PCR was used to amplify HBV DNA in 163 cases of HBV-infected carriers, liver cirrhotic and hepatocellular carcinoma patients from The Third People's Hospital of Hainan. HBV DNA was identified by polymerase chain reaction-restriction fragment length polymorphism. At the same time, the ethics, clinical data and laboratory test results of patients were collected. SPSS statistical software was used for t-test, Chi-square test and Logistics regression analysis.Results A total of 207 serum samples from patients with hepatitis B virus infection were tested, while 44 did not have valid genotype data. Of 163 HBV-infected individuals with specific genotypes, 25 samples were HBV B genotype (15.3%), 132 samples were HBV C genotype (81.0%), and 6 HBV B / C mixed type accounted for 3.7%. Age, gender, ethnicity, disease status, positive rate of HBeAg and HBV DNA level among HBV genotypes were not statistically significant. Aspartic transferase (AST) levels in patients with HBV C infection were higher than those with HBV infection. Among all HBV C genotypes, liver cirrhosis and liver cancer accounted for the highest proportion of patients. Patient ADA values were significantly associated with HBV genotype status, according to Logistic regression results. Patients with elevated ADA values were more likely to be HBV B genotype (P=0.044).Conclusion The HBV genotypes of hepatitis B patients in Hainan are mainly C type. The liver function of patients with HBV C genotype infection is more likely to be impaired. The patients with HBV C genotype are more likely to have lower ADA value, and is likely to progress to liver cirrhosis and liver cancer clinically.