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目的探讨乙型肝炎病毒(HBV)基因型和亚型与慢性乙型肝炎(CHB)发病的关系。方法对454例CHB患者,定量PCR方法检测HBV DNA为阳性,再以型特异性引物PCR法检测HBV基因型及其亚型。结果 (1)454例HBV DNA阳性的CHB患者其中HBV B基因型68例(14.9%);其中Ba亚型35例,Bj亚型3例,未分B亚型30例,C基因型338例(74.5%),C基因型中C1亚型3例,C2亚型285例,未分型50例。B+C混合基因型48例(10.6%),均为Ba+C2基因型;(2)B与C基因型比较,B基因型中HBeAg阴性的患者多于HBeAg阳性的患者(2χ=17.69,P<0.001)。CHB患者中C基因型的HBeAg阳性率明显高于B基因型(χ2=17.025,P=0.000)。(3)定量PCR检测B基因型HBV水平低于其他基因型;C基因型HBV复制高于其他基因型。结论我国CHB患者中HBV基因型以C基因型为主;HBV基因亚型中Ba与C2亚型是主要的亚型,不同的HBV亚型间病毒载量差异有统计学意义;HBeAg阳性或HBeAg阴性的CHB患者中HBV基因型分布不同;HBV基因型和亚型的临床意义值得动态观察。
Objective To investigate the relationship between hepatitis B virus genotypes and subtypes and the incidence of chronic hepatitis B (CHB). Methods A total of 454 CHB patients were tested for HBV DNA by quantitative polymerase chain reaction (PCR) and HBV genotypes and subtypes were detected by PCR. Results Among the 454 CHB patients with HBV DNA positive, HBV B genotype was 68 (14.9%). Among them, 35 cases were Ba subtype, 3 subtype Bj, 30 subtype B subtype and 338 C subtype (74.5%). There were 3 cases of C1 subtype in C genotype, 285 cases of C2 subtype in 50 cases. (2) The genotypes of B and C were more in HBeAg-negative patients than in HBeAg-positive patients (2χ = 17.69, P <0.001). The HBeAg positive rate of C genotype in CHB patients was significantly higher than that in B genotype (χ2 = 17.025, P = 0.000). (3) Quantitative PCR detection of HBV genotype B was lower than other genotypes; HBV genotype C was higher than other genotypes. Conclusions The genotypes of HBV in CHB patients in our country are mainly C genotypes; Ba and C2 subtypes of HBV genotypes are the major subtypes, and the viral load of different HBV subtypes is statistically different; HBeAg-positive or HBeAg HBV genotypes are different in patients with negative CHB; the clinical significance of HBV genotypes and subtypes is worthy of dynamic observation.