HBV慢性感染者PC/BCP区变异特点及血清检测指标临床意义

目的探讨慢性乙型肝炎病毒(hepatitis B virus,HBV)感染者前核心区(precore,PC)和基本核心启动子(basalcore promoter,BCP)变异特点以及变异株血清乙肝病毒e抗原(hepatitis B e antigen,HBeAg)、乙肝病毒表面抗原(hepatitis B surface antigen,HBsAg)、乙肝病毒脱氧核酸(HBV-DNA)检测的临床意义。方法采集138例慢性HBV感染者清晨空腹血,以免疫化学发光法检测血清HBeAg、HBsAg,并同时采用磁珠法检测HBV-DNA,应用半巢式聚合酶链反应检测PC/BCP区基因突变。结果 101例未经抗病毒治疗的慢性HBV感染者中,HBeAg阴性组PC、BCP、PC+BCP变异率高于HBeAg阳性组,差异有统计学意义(P0.05)。37例服用核苷类药物一年以上组PC、BCP、PC+BCP检出率要高于未经抗病毒治疗的HBeAg阳性HBV感染者组(P0.05)。HBeAg阴性HBV感染患者其PC、BCP和PC+BCP的变异率随着病程的增加而增加(P0.01)。PC、BCP和PC+BCP变异株组与野生株比较,慢性HBV感染者HBeAg含量减少(P0.05),DNA复制活跃、HBsAg含量增加(P0.01)。结论变异的发生使HBeAg阴性的慢性HBV感染患者越来越多,服用核苷类抗病毒药物和长的疾病病程可能是变异相关因素。对于HBeAg阴转的慢性HBV感染患者观察DNA、HBsAg含量,可了解体内病毒是否确实已被免疫清除。

Clinical significance of PC/BCP region variation and the serum parameters in HBV chronic infection patients

Objective To analyze the variation characteristics of precore (PC) and basal core promoter (BCP) and investigate the clinical significance of mutant strain serum HBeAg,HBsAg and DNA in patients with chronic HBV infection.Methods We collected fasting blood of 138 patients with chronic HBV infection,the serum HBeAg,HBsAg were detected by immune chemiluminescence,HBV-DNA were detected by magnetic beads method,and PC/BCP gene mutation were detected by semi nested polymerase chain reaction.Results In 101 cases without antiviral treatment of patients with chronic HBV infection,the PC,BCP,PC+BCP mutation rate in the HBeAg negative group was significantly higher than that in the HBeAg positive group (P＜0.05).The PC,BCP,PC+BCP mutation rate of 37 patients who received nucleoside drugs for more than one year were higher than those of HBV infected patients who did not take nucleoside drugs (P＜0.05).The rate of PC,BCP and PC +BCP in patients with HBeAg negative HBV infection increased with the duration of disease (P＜0.01).The HBeAg content of PC,BCP and PC+BCP variant strains was decreased compared with wild strains (P＜0.05) in patients with chronic HBV infection,while the DNA and HBsAg content increased (P＜0.01).Conclusion The incidence of HBV variation increased patients with HBeAg negative chronic hepatitis B infection,and the nucleoside antiviral drugs and long course of disease may be related to the mutation.For patients with chronic HBV infection of HBeAg,the DNA and HBsAg content of HBV infection can be found to understand whether the virus has indeed been eliminated.