39例成人急性乙型肝炎患者血清HBV基因变异检测及其临床意义探讨*

目的了解成人急性乙型肝炎患者流行的病毒基因型及基因变异情况。方法在2010年12月~2014年1月北京佑安医院收治39例急性乙型肝炎患者,采用直接基因测序法和平行等位基因特异性检测技术检测HBV基因型、P区、S区、前C区（PreC）和基本核心启动子（BCP） 区序列。结果在39例患者中,成功测序35例。35例急性乙型肝炎患者感染HBV B基因型12例（36.4%）,C基因型21例（57.6%,D基因型2例（6.0%）;通过直接测序法和PASS法均检测到同1例患者存在A181S耐药变异,变异病毒占准种池比例达100%;直接测序法检测到1例患者存在S区S132F和W172C变异;1例患者存在PreC/BCP 区G1896A和T1758C变异。结论急性乙型肝炎患者感染病毒基因型与文献报道的慢性乙型肝炎患者感染病毒基因型分布一致,以C型和B型为主,存在P区、S区和PreC/BCP区变异可能,未见不同病毒株感染引起转归的不同。

Hepatitis B viral genotypes and gene mutations in 39 adult patients with acute hepatitis B

Objective To investigate the prevalent viral genotypes and possible gene mutation in adults with acute hepatitis B（AHB）. Methods Serum samples of 39 patients with AHB admitted in our hospital were collected between December 2012 and January 2014. Viral genotypes and sequences of P region,S region,Pre C region and basic core promoter（BCP） were detected by direct sequencing and parallel allele specific sequencing （PASS）. Results 35 out of 39 patients with AHB were sequenced successfully. Genotype distribution in these 35 cases was as follows. Genotype B accounted for 36.4% （12/35）,genotype C for 57.6% （21/35）,and genotype D for 6.0%（2/35）;A181S drug resistance mutation was found in one patient by both sequencing methods,while S132F and W172C mutations in S region as well as G1896A and T1758C mutations in PreC/BCP regions were noticed by direct sequencing in two different cases,respectively. Conclusions Viral genotype distribution of common genotype C and B in patients with AHB is not different in patients with CHB. Patients infected with P region,S region or PreC/BCP region mutants might have similar prognosis as patients infected with wild HBV.