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目的比较B、C基因型慢性乙型肝炎患者(慢乙肝)在临床特征上的差异,总结与C基因型乙型肝炎有关的临床因素。方法选择经肝穿刺行肝组织病理检查、并经基因型检测确定为B、C基因型的患者共78例,检测血清HBV DNA载量,统计重型肝炎、肝硬化、肝细胞癌和HBeAg阳性发生率,确定肝组织病理炎症分级及纤维化分期。通过X~2检验和多分类Logistic多元回归,分析B、C基因型患者间上述指标的差异,总结与HBV C基因型有关的临床因素。结果HBV C基因型慢乙肝患者血A1b、前白蛋白均低于B基因型,而ALT、TBil及凝血酶原时间(PT)均高于B基因型,差异有统计学意义。HBV C基因型慢乙肝患者比率随肝组织炎症分级GO～G4(1.8%、11.1%、20.4%、33.3%、33.3%)及纤维分期SO～S4(5.6%、5.6%、14.8%、33.3%、40.7%)进展均明显增加,而B基因型患者随炎症分级(16.7%、25.0%、25.0%、20.8%、12.5%)及纤维分期(16.7%、29.2%、20.8%、16.7%、16.7%)进展变化不大,两种基因型分布与炎症分级(X~2=11.49,P=0.022)及纤维分期(X~2=13.56,P=0.006)差异均有统计学意义。在HBV DNA>1.0×10~6拷贝/mL时,C基因型患者比率明显高于B基因型(51.8%比12.5%),5.0×10~2～1.0×10~6拷贝/mL时差异不大(35.2%比45.8%),<5.0×10~2拷贝/mL时明显低于B基因型(13.0%比41.7%),两种基因型分布与DNA载量差异有统计学意义(X~2=13.25,P=0.001);C基因型慢乙肝患者HBeAg阳性率明显高于B基因型(61.1%比25.0%),差异有统计学意义(X~2=8.67,P=0.003);C基因型患者发生失代偿期肝硬化比率明显高于B基因型(40.7%比4.2%),未发生肝硬化比率明显低于B基因型者(37.0%比75.0%),两种基因型患者发生肝硬化比率差异有统汁学意义(X~2=12.47,P=0.002)。结论C基因型慢乙肝患者与肝纤维化、炎症损伤程度、HBV标志物、肝硬化发生率及程度等均有较高的相关性。
Objective To compare the clinical characteristics of patients with chronic hepatitis B and B genotype C (chronic hepatitis B) and summarize the clinical factors related to hepatitis C with genotype C. Methods A total of 78 patients with B and C genotypes were selected by liver biopsy. The serum HBV DNA load, statistics of severe hepatitis, cirrhosis, hepatocellular carcinoma and HBeAg positive were detected Rate, to determine the pathological grade of liver inflammation and fibrosis staging. Through X ~ 2 test and multi-classification Logistic multiple regression, the differences of the above indexes in patients with genotype B and C were analyzed, and the clinical factors related to HBV C genotype were summarized. Results The serum levels of A1b and prealbumin in patients with chronic hepatitis B with HBV C genotype were lower than those with genotype B while the ALT, TBil and PT were higher than those with genotype B, the difference was statistically significant. The proportion of chronic hepatitis B patients with HBV C genotype was significantly higher than that of patients with chronic hepatitis B (GO ~ G4, 1.8%, 11.1%, 20.4%, 33.3%, 33.3% , 40.7%, respectively). However, the patients with B genotype had significantly higher progression grade (16.7%, 25.0%, 25.0%, 20.8%, 12.5%) and fibrosis stage (16.7%, 29.2%, 20.8%, 16.7%, 16.7 %) Did not change much. The differences of the distribution of the two genotypes with the grading of inflammation (X ~ 2 = 11.49, P = 0.022) and fibrosis stage (X ~ 2 = 13.56, P = 0.006) were statistically significant. The proportion of patients with genotype C was significantly higher than that of genotype B (51.8% vs. 12.5%) at HBV DNA> 1.0 × 10 ~ 6 copies / mL, and no difference was found at 5.0 × 10 ~ 2 ~ 1.0 × 10 ~ 6 copies / mL (35.2% vs. 45.8%), <5.0 × 10 ~ 2 copies / mL was significantly lower than that of B genotype (13.0% vs. 41.7%), and there was significant difference between the two genotype distribution and DNA loading (X ~ 2 = 13.25, P = 0.001). The positive rate of HBeAg in C genotype chronic hepatitis B patients was significantly higher than that in B genotypes (61.1% vs 25.0%, P = 0.003) Patients with genotypes had a significantly higher proportion of patients with decompensated cirrhosis than those with genotype B (40.7% vs. 4.2%), patients with no evidence of cirrhosis (37.0% vs. 75.0%), and patients with both genotypes Differences in the occurrence of cirrhosis have the meaning of the whole juice (X ~ 2 = 12.47, P = 0.002). Conclusions C genotype chronic hepatitis B patients with liver fibrosis, the degree of inflammatory damage, HBV markers, the incidence and extent of cirrhosis have a higher correlation.