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目的 探讨HBeAg阴性慢性乙型肝炎患者出现前C区G1896A突变和基本核启动子(BCP)区A1762T/G1764A 双突变,以及两者的联合突变对患者血清病毒含量的影响。方法 收集240份HBeAg阴性、60份HBeAg阳性慢性乙型肝炎患者血清及40份阴性对照血清,采用竞争分化聚合酶链反应(CD PCR)检测G1896A突变及A1762T/G1764A 双突变,采用实时荧光定量聚合酶链反应(PCR)检测血清中病毒含量。结果 G1896A突变在HBeAg阴性和HBeAg阳性患者中的检出率分别为57.6%和6.7%;A1762T/G1764A双突变的检出率分别为37.9%和31.7%;其中两者联合突变在HBeAg阴性患者中的检出率为13.5%。在HBeAg阴性患者中,G1896A突变主要出现在血清病毒含量低的患者,而A1762T/G1764A 双突变与血清病毒含量无关。联合变异株主要见于重度慢性乙型肝炎患者,与血清病毒含量无关。结论 G1896A 变异株复制能力较低,而A1762T/G1764A变异株对病毒复制能力影响可能较为复杂,对HBeAg合成的影响较G1896A变异株小。联合变异株的致病力相对较强,其复制能力较单纯G1896A强,值得警惕。
Objective To investigate the effect of G1896A mutation in pre-C and A1762T / G1764A double mutation in basic nuclear promoter (BCP) in patients with HBeAg-negative chronic hepatitis B, and their effects on serum viral load. Methods Serum of 240 HBeAg-negative and 60 HBeAg-positive chronic hepatitis B patients and 40 negative control serum were collected. Mutations of G1896A and A1762T / G1764A double mutants were detected by competitive polymerase chain reaction (CD PCR). Real-time fluorescence quantitative polymerase chain reaction Enzyme-linked reaction (PCR) detection of serum virus content. Results The positive rates of G1896A mutation were 57.6% and 6.7% in HBeAg-negative and HBeAg-positive patients respectively. The positive rates of A1762T / G1764A double mutation were 37.9% and 31.7% respectively. The combined mutation of G1896A and HBeAg in HBeAg-negative patients The detection rate was 13.5%. In HBeAg-negative patients, G1896A mutation mainly in patients with low serum viral content, and A1762T / G1764A double mutation has nothing to do with serum viral content. Joint variant strains are mainly found in patients with severe chronic hepatitis B, and serum levels of virus has nothing to do. Conclusion The G1896A variant has a lower ability to replicate, while the A1762T / G1764A variant may have a more complicated effect on the replication of the virus and has less effect on the HBeAg synthesis than the G1896A variant. The virulence of the joint variant strains is relatively strong, its replication ability is stronger than G1896A alone, worth vigilance.