探讨前C区A1896变异与乙型肝炎病毒相关的进展性肝病的关系

目的探讨前C区A1896变异与乙型肝炎病毒（HBV）相关的进展性肝病的关系。方法选择172例HBV感染者,采用PCR-RFLP进行A1896变异的检测,并对其临床意义进行分析。结果172例患者A1896变异的总体检出率为45.9%。在A1896变异株和野生株中,慢性无症状携带者（ASC）、慢性乙型肝炎（CHB）、肝硬化（LC）、慢性重型肝炎（CSH）、肝细胞癌（HCC）的构成比差异有统计学意义（P〈0.05）。CHB、LC、CSH、HCC的A1896变异率分别为39.7%、52.0%、50.0%、74.1%,显著高于ASC的12.5%（P〈0.05）。进展性肝病（包括CSH、LC、HCC）的A1896变异率为59.0%,显著高于CHB的39.7%（P〈0.05）。慢性乙型肝病不同临床类型的A1896的野生株、变异株构成比差异无统计学意义（P〉0.05）。HBeAb阳性组的A1896变异率为73.2%,显著高于HBeAg阳性组的28.1%（P〈0.05）。A1896野生株HBeAg阳性率显著高于变异株（45.2%vs 19.0%,P〈0.05）。变异株HBV-DNA复制的均数水平显著高于野生株（9.55±4.65）lg copies.L-1vs（10.35±4.49）lg copies.L-1,P〈0.01]。结论A1896变异与HBV相关的进展性肝病有关,但与CHB的炎症活动程度无关。A1896变异株的HBeAg阴性率和HBV-DNA病毒载量较野生株高,前者使HBV易逃避免疫清除,后者引起疾病逐步进展。

Correlation between Precore Mutation with A1896 and Progressive Liver Disease in Chronic HBV Infection

Objective To study the correlation between precore mutation with A1896 and progressive liver disease in chronic HBV infection.Methods Precore mutant with A1896 was determined by PCR-RFLP in 172 patients with HBV infection to investigate its clinical significance.Results Mutation rate with A1896 was 45.9% in 172 patients.The constituent ratio of A1896 and G1896（wild type） in patients with asymptomatic HBV carriers（ASC）,Chronic hepatitis B（CHB）,liver cirrhosis（LC）,Chronic severe hepatitis（CSH）,and hepatocellular carcinoma（HCC） were significantly different（P0.05）.Mutation rates with A1896 in patients with CHB,LC,CSH,HCC）were 39.7%,52.0%,50.0%,74.1%,much higher than that of 12.5% in ASC patients respectively（P0.05）.Mutation rates with A1896 in patients with advanced stages of liver disease in chronic HBV infection（including CSH,LC,HCC）was 59.0%,much higher than that of 39.7% in CHB patients（P0.05）.The constituent ratio of A1896 and G1896（wild type） in CHB patients with different clinical types were not significantly different（P0.05）.Mutation rate with A1896 in HBeAb-positive patients was 73.2%,much higher than that of 28.1% in HBeAg-positive patients（P0.05）.The positive rate of HBeAg in patients of mutation with A1896 was much higher than that of wild type,the difference was significant（45.2% vs 19.0%,P0.05）.The mean levels of HBV-DNA copy in patients of mutation with A1896 was higher than that of wild type,the difference was significant（9.55±4.65）lg copies·L-1 vs（10.35±4.49）lg copies·L-1,P0.01].Conclusion Precore mutation with A1896 correlates with advanced stages of liver disease in chronic HBV infection,but don＇t correlate with inflammatory activity level of CHB.HBeAg-negative rate and levels of HBV-DNA copy in patients of A1896 were higher than those of wild type.The former caused HBV to escopc immunity clearance,the latter made disease advanced.