乙型肝炎病毒基因型与基本核心启动子及前C区变异对疾病进展的影响

目的 应用测序列的方法，探讨乙型肝炎病毒（HBV）基因型在南京地区的流行病学状况和HBV基因型与基本核心启动子（BCP）及前C区变异对疾病进展的影响。方法 选用南京地区94例HBV感染患者血清，其中慢性乙型肝炎（CHB）44例、慢性重型乙型肝炎（CSH）、肝硬化（LC）和肝细胞癌（HCC）50例，应用测序列的方法测定HBV的S基因序列以确定其基因型，测定C基因序列以确定其变异状况。结果 南京地区94例HBV感染患者的HBV基因型以B型和C型为主，分别为40例（42．6％）和54例（57．4％），未发现其他型和混合型，CHB组与HCC、CSH和LC组病毒基因型分布差异有统计学意义（P〈0．01），对于不同病情的HBV感染患者，基本核心启动子变异区（T1762／A1764双变异）变异差异有统计学意义（P〈0．05）；而不同基因型的患者基本核心启动子变异差异有统计学意义（P〈0．05）。前C区变异（A1896变异）在不同病情和不同基因型的患者中，差异均无统计学意义。结论 南京地区流行的HBV主要基因型是B和C，C型感染可以引起较重的肝病，尤其是BCP发生双变异者；HBV基因型是影响临床表现的重要因素之一。

Influence of basic core promoter/precore mutations and genotypes of hepatitis B virus on advance of liver disease

Objective To study the distribution of hepatitis B virus(HBV) genotype and its clinical significance and the influence of the basic core promoter,precore mutations and genotypes of HBV on advance of liver disease.Methods Serum samples from 94 patients with HBV infection in Nanjing,including 44 cases of chronic hepatitis B(CHB),50 cases of severe chronic hepatitis B(CSH),liver cirrhosis(LC) and hepatocellular cancinoma(HCC) were collected.The patients were tested for HBV genotypes by using direct S gene sequencing and for the basic core promoter/precore mutations by C gene sequencing.Results Of 94 cases in Nanjing,40 cases((42.6%)) were genotype B and 54 cases((57.4%)) genotype C.No other genotypes and mixing genotypes were found.There were different genotypes distribution between CHB and HCC,CSH and LC groups(P<(0.01)).There were statistically difference in T1762/A1764 double-mutations in different liver diseases groups(P<(0.05)) and in different genotypes groups(P<(0.05)).But no statistically significant difference was observed between A1896 mutations in different liver diseases groups and different genotypes groups.Conclusion Genotype B and C were predominated in Nanjing.HBV with genotype C related with severe liver diseases,especially T1762/A1764 double-mutations.The genotype of HBV was one of the important factors among clinical representations.