乙型肝炎相关慢加急性肝衰竭患者乙型肝炎病毒前C/C区联合突变特点分析

闫涛，李梵，李克等.乙型肝炎相关慢加急性肝衰竭患者乙型肝炎病毒前C/C区联合突变特点分析[J].临床肝胆病杂志, 2013, 29(2).120-123,127

肝炎,乙型 肝功能衰竭 DNA突变分析

闫涛，李梵，李克，赵平，王慧芬

(北京解放军第三○二医院肝衰竭诊治研究中心,北京,100039)；

2013

120-123,127

知网,万方

目的 分析乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者HBV前C/C区联合突变的特征.方法 入选166名慢性HBV感染者,其中ACLF 49人,慢性乙型肝炎(CHB) 45人,肝硬化(LC)45人,肝细胞癌(HCC) 27人,对HBV前C/C区片段进行PCR扩增,分析突变数量及联合突变状况.结果 ACLF患者多联突变比例明显高于其他组患者.4组之中,ACLF组5联突变和7联突变者比例最高,分别是20.4％(10/49)和12.2％ (6/49),6联突变者与HCC组相近分别为14.3％(7/49)和14.8％ (4/27),明显高于CHB和LC组.联合突变组合形式的分析结果提示,ACLF组患者,含nt 1846和nt1913突变的联合突变组合阳性率在4组患者中最高.结论 ACLF患者HBV前C/C区多联突变比例高于其他慢性HBV感染者；以nt1846和nt1913为基础的联合突变率最高. To analyze the mutational patterns of the pre一C/C region of hepatitis B virus（HBV） in patients with HBV一associ-ated acute一on一chronic liver failure（HBV一ACLF ）。Methods A total of 166 patients with chronic HBV infection were enrolled in thestudy，including 49 cases of ACLF, 45 cases of chronic hepatitis B（CHB），45 cases of liver cirrhosis（LC），and 27 cases of hepatocellularcarcinoma（HCC）。The pre一C/C region of HBV was amplified by poly0merase chain reaction and then analyzed to determine the number ofmutations and mutational patterns. Results Multi一site mutations occurred significantly- more frequently in ACLF patients than in other pa-tients. Among the four groups of patients, those with AGLF had the highest rates of 5一site and 7一：ite mutations[20.4%（10/49）and12.2 % （ 6/49 ）];they had a similar rate of 6一site mutations as HCC patients[14.3% （7/49） vs. 14.8% （4/27）]，but this was signif-icantly higher than patients with CHB and LC. The mutational pattern analysis showed that multi一site mutations that included those at nt1846 and nt 1913 were more likely to occur in patients with ACLF than in the other groups. Conclusion Compared with other patientgroups with chronic HBV infection, ACLF patients had a higher frequency of multi一site mutations in the pre一C/C region of HBV, with thehighest rates of mufti一site mutations containing mutations at nt 1846 and nt 1913.