甘肃地区汉族HCV基因分型相关分析

目的调查甘肃地区汉族丙型肝炎病毒（HCV）基因分型分布情况及与其可能的传播途径、其他相关临床指标之间的关系。方法收集甘肃地区汉族220例患者完整数据，包括性别、年龄、可能的感染途径、病毒水平及生化检查。计量资料采用t检验以及秩和检验分析，计数资料采用卡方检验，采用多因素Logistic回归分析研究HCV基因型与临床的相关性。结果220例患者共检出1b型84例（38％），2a型136例（62％）。对220例不同HCV基因型感染者的年龄、性别、感染途径、HCVRNA、ALT、AST、TBil、IBil、DBil、ALP、GGT等11项观察指标进行单因素分析结果表明，感染途径、HCVRNA及A¨与HCV基因型问存在相关性（Ⅳ0=23．947，P〈0．001；Z=一3．349，P=0．001；t=-2．325，P=0．021），而年龄、性别、AST、TBil、IBil、DBil、ALP、GGT等指标均与HCV基因型无关（P〉0．05）。再经多因素Logistic回归分析显示，该3项均与HCV基因型有关（矿=3．993，P=0．046；矿=9．308，P=0．002；x^2=11．652，P=0．001）。Logistic回归分析结果显示HCVRNA高水平复制（≥10^6）患者中感染2a型较1b型患者多；ALT异常（〉49U／L）患者中感染2a型者较之感染1b型患者多；通过输血途径、口腔感染途径感染1b型的概率，较之其他途径高。结论甘肃地区汉族人群中HCV感染主要为基因1b型及2a型，且2a型较1b型更为常见。2a型患者更容易出现HCVRNA的高水平复制，且可能更容易出现肝脏损伤。输血途径感染是甘肃地区主要感染HCV的方式，其次为口腔感染，而通过以上2种感染方式感染HCV的患者1b型较2a型多。

Genotypes of HCV in hepatitis C patients of Han nationality in Gansu,China

Objective To investigate the genotypes of hepatitis C virus （HCV） among the hepatitis C patients of Han nationality in Gansu, China, as well as their possible routes of transmission and relationship with clinical indices. Methods The complete data regarding hepatitis C, including sex, age, possible routes of transmission, HCV RNA level, and biochemical parameters, were collected from 220 hepatitis C patients of Han nationality in Gansu. Continuous data were analyzed by t test and rank sum test; categorical data were analyzed by chi - square test; multivariate logistic regression analysis was used to investigate the relationship between HCV genotypes and clinical indices. Restilts HCV genotype lb was detected in 84 （38%） of all patients, and genotype 2a in 136 （62%） of these patients. The univariate analysis of 11 tactors including age, sex, route of transmission, HCV RNA, alanine aminotransferase （ ALT）, aspartate aminotransferase （ AST）, total bilirubin （ TBil）, indirect bilirubin （ IBil）, direct bilirubin （ DBil）, alanine phosphatase （ ALP）, and gamma - glutamyl transpeptidase （GGT） showed that the route of transmission, ALT, and HCV RNA were correlated with HCV genotypes （x^2 = 23. 947, P 〈0. 001 ; Z = -3. 349, P=0. 001; t = -2. 325, P=0.021）, but age, sex, AST, TBil, IBbil, DBil, ALP, and GGT were not correlated with HCV genotypes （ P 〉 0.05 ）. The multivariate logistic regression analysis showed that the above three factors were correlated with HCV genotypes （x^2 =3. 993, P =0. 046; X2 =9. 308, P =0. 002; X2 = 11. 652, P=0. 001 ）. The number of genotype 2a patients was larger than that of genotype 1 b patients among patients with high HCV RNA levels （≥106 IU/ml） and those with high ALT levels （ 〉 49 U/L）. HCV geno- type 1 b was more likely to be transmitted by blood transfusion and oral treatment compared with other routes. Conclusion Genotype 1 b and genotype 2a are the main genotypes of HCV among the hepatitis C patients of Han nationality in Gansu, and genotype 2a is more common. Genotype 2a patients are more prone to high HCV RNA level and liver damage. In Gansu, HCV is transmitted mainly by blood transfusion, followed by oral treatment, and genotype 1b is more likely than genotype 2a to be transmitted by the two routes.