嘉兴地区乙肝病毒基因分型与病理及耐药的关系

目的：了解嘉兴地区慢性乙型肝炎（CHB）患者乙型肝炎病毒（HBV）基因型分布的特点，探讨基因型与病理及核苷类药物耐药之间的关系。方法采用荧光定量聚合酶链反应方法检测85例CHB患者的HBV基因型，同时检测血清HBV DNA、乙肝三系、核苷类药物耐药，并进行肝组织病理检查。结果85例CHB患者B基因型32例（37.65％）、C基因型53例（62.35％），C基因型患者的HBV DNA水平、HBeAg阳性率均明显高于B基因型，差异均有统计学意义（t=2.78，χ2=8.03，P均＜0.05）。肝组织炎症坏死及肝纤维化的进展程度，C基因型较B基因型明显加重，差异均有统计学意义（χ2分别=8.82、10.67，P均＜0.05），C基因型较B基因型发生拉米夫定、替比夫定耐药更多，差异均有统计学意义（χ2分别=4.03、4.03， P均＜0.05）。结论嘉兴地区CHB患者HBV基因型以C型为主，C型HBV复制能力强，拉米夫定、替比夫定耐药更多，更易导致严重肝脏病变。HBV基因分型对判断肝脏病变的严重程度和指导临床抗病毒治疗具有重要意义。

Relationship of hepatitis B virus genotyping,pathology and drug resistance in Jiaxing

Objective To understand the distribution characteristics of hepatitis B virus（HBV） genotype in chronic hep-atitis B （CHB） patients and explore the relationship between the genotype, pathological and nucleoside drugs resistance. Methods The HBV genotypes of 85 cases of patients with CHB were detected by fluorescence quantitative polymerase chain reaction （PCR）. The serum HBV DNA, three series of hepatitis b and nucleoside drugs resistance were detected and liver tissue pathologic were examined. Results There were 32 cases （37.65%）of B genotype in 85 patients with CHB, 53 cases（62.35%） of C genotype. HBV DNA levels, HBeAg positive rate of C genotype patients were significantly higher than B genotype （t=2.78,χ2=8.03,P〈0.05）. Inflammation of the liver tissue necrosis and the progression of liver fibrosis of C genotype patients were significantly more serious than B genotype （χ2=8.82,10.67,P〈0.05）. The lamivudine and telbivu-dine resistances of C genotype were significantly more than B genotype （χ2=4.03,4.03,P〈0.05）. Conclusion The main HBV genotype in patients with CHB in Jiaxing is C genotype, whose replication ability is strong and more resistable for lamivudine and telbivudine, more likely to lead to severe liver disease. It is significance to judge the severty of liver dis-ease and guide clinical treatment with HBV genotype.