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目的探讨HBeAg阴性慢性乙型肝炎(以下简称e-CHB)的临床特点及与前C区G1896A变异及基本核心启动子(BCP)区A1762T/G1764A双变异的关系。方法采用实时荧光定量PCR法检测HBVDNA,采用时间分辨荧光免疫分析法定量检测乙型肝炎病毒标志物,采用基因芯片检测基因变异。结果e-CHB患者其年龄、肝硬化及肝癌发生明显高于HBeAg阳性慢性乙型肝炎(以下简称e+CHB)患者(P<0·05);e-CHB患者在HBVDNA定量,慢性轻度肝炎比例明显低于e+CHB患者(P<0·05)。前C区G1896A变异及BCP区A1762T/G1764A双变异的总的变异率,e-CHB患者明显高于e+CHB患者(χ2=6·66,P<0·01)。结论e-CHB患者年龄较大,肝硬化、肝癌发生率高,在慢性乙型肝炎自然史中处于较晚阶段。e-CHB病毒复制减少。e-CHB主要是基因变异的结果;血清不同e系统均可发生变异。
Objective To investigate the clinical features of HBeAg-negative chronic hepatitis B (e-CHB) and its relationship with the G1896A mutation in the pre-C region and the A1762T / G1764A double-mutation in the basic core promoter (BCP) region. Methods HBVDNA was detected by real-time fluorescence quantitative PCR, time-resolved fluorescence immunoassay was used to detect hepatitis B virus markers, and gene chips were used to detect the gene mutation. Results The patients with e-CHB had significantly higher age, cirrhosis and liver cancer than those with HBeAg-positive chronic hepatitis B (hereinafter referred to as e + CHB) (P <0.05) The proportion was significantly lower in e + CHB patients (P <0.05). The total mutation rate of G1896A in pre-C region and A1762T / G1764A in BCP region was significantly higher in e-CHB patients than in e + CHB patients (χ2 = 6.66, P <0.01). Conclusions Patients with e-CHB are older, have a higher incidence of liver cirrhosis and hepatocellular carcinoma, and are at a later stage in the natural history of chronic hepatitis B. e-CHB virus replication reduced. e-CHB is mainly the result of genetic variation; different e-system of serum can be mutated.