乙肝病毒基因型与肝脏病理改变的关系

目的:探讨乙型肝炎病毒基因型与慢性乙型肝炎患者肝脏病理变化的关系.方法:应用乙肝病毒型特异性引物采用巢式聚合酶链反应(PCR)和荧光定量聚合酶链反应(FQ-PCR),对北京佑安医院住院92例慢性乙型肝炎患者进行乙型肝炎病毒基因型及亚型分析,参照2000年《病毒性肝炎防治方案》对慢性肝炎进行病理分级、分期诊断.结果:92例慢性乙型肝炎患者中HBV基因型分布为B型17例(B2亚型),B/C混合型17例(B2/Ca亚型),C型58例(Ca亚型).17例HBV B型感染患者中病理诊断肝脏炎症活动分级为G1-G3期分别为35.29%,58.82%,5.88%;肝脏纤维化程度分级为S1-3级分别为58.82%,29.41%,11.76%,17例HBV B/C型感染患者中病理诊断肝脏炎症活动分级为G1-G3期35.29%,52.94%,11.76%;肝脏纤维化程度分级为S1-3级23.52%,52.94%,23.52%,58例HBV C型感染患者中病理诊断肝脏炎症活动分级为G1-G4期31.03%,24.14%,36.21%,8.62%;肝脏纤维化程度分级为S1-4级25.86%,39.66%,5.17%,29.31%;HBV三组不同基因型的慢性乙型肝炎患者肝组织病理检查有统计学意义(x~2=15.13,P<0.01).HBV B型与B/C型感染患者年龄在21-30岁组58%-76%,31-40岁组17.6%-29.4%,C型感染患者年龄在21-30岁组25%,31-40岁组46.6%,40岁以上有24.24%;不同HBV基因型感染患者的年龄分布有显著性差异(x~2=9.54,P<0.05).结论:慢性乙型肝炎患者HBV基因型中C型比例明显高于B型与B/C型.HBV C型患者肝脏病理变化较B型与B/C型严重.不同HBV基因型感染患者的年龄分布不同.

Relationship between the histology and genotype of hepatitis B virus DNA in chronic hepatitis B patients

AIM:To investigate the relationship between hepatitis B virus DNA genotype and pathological changes in patients with chronic hepatitis B. METHODS:A total of 92 chronic hepatitis B (CHB)patients were tested for HBV genotype and sub-genotypes by nested and fluorescence quantitative polymerase chain reactions,re- spectively.Liver biopsy specimens of all pa- tients were taken and histological activity index (HAI)necroinflammation(HAI-NI),and fibrosis (HAI-F)scores were calculated. RESULTS:Among the 92 cases,17(18.48%)had genotype B(sub-genotype B2),17(18.48%)had mixed B/C genotype(sub-genotype B2/Ca)and 58(63.04%)had C(sub-genotype Ca)infections. In the 17 CHB patients with genotype B,HAI- NI were 35.29%,58.82% and 5.88% for G1,G2 and G3,respectively,HAI-F scores were 58.82%, 29.41% and 11.76% for S1,S2,and S3,respective- ly;In the 17 cases with mixed B/C genotype in- fection,HAI-NI were 35.29%,52.94% and 11.76% for G1-G3,respectively,HAI-F were 23.52%, 52.94%,23.52% for S1-S3,respectively;In the 58 patients with genotype C,HAI-NI was 31.03%, 24.14%,36.21% and 8.62% for G1-G4,respective- ly,HAI-F were 25.86%,39.66%,5.17%,29.31% for S1-S4,respectively.There were significantly differences in the HAI-NI and HAI-F scoring in patients with different HBV genotypes(x~2= 15.13,P<0.01).The ages of CHB patients were significantly different between the HBV geno- types C and B.The frequencies were 58%-76% for those 21-30 years old,17.6%-29.4% for 31-40 in genotype B,and 25% for 21-30 years old, 46.6% for 31-40,and 24.24% for>40 in genotype C(x~2=9.54,P<0.05). CONCLUSION:The most common HBV geno- type was C.Patients with HBV C had severer in- fections than those of other genotypes.Further, different HBV genotypes infected different ages of HBV patients.