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邢台地区HCV基因型分布特征及其与疾病进展和持续病毒学应答的关系
An analysis of related factors for hepatitis C genotyping and sustained virologic response in Xingtai, China
文章发布日期:2015年10月14日  来源:  作者:张彦芳,赵冬梅,张彦敏,等  点击次数:1926次  下载次数:312次

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【摘要】:目的分析邢台地区丙型肝炎患者病毒基因型分布特征,及其与疾病进展程度和持续病毒学免疫应答(SVR)的关系,为其预后判断提供依据。方法选取2010年12月-2014年12月邢台市人民医院收治的邢台地区丙型肝炎患者231例,收集患者一般资料,测定ALT、AST、白细胞(WBC)、基因分型及病毒载量。计量资料采用方差分析,计数资料采用χ2检验进行统计学分析。结果231例患者中1b亚型109例(47.2%),其次为2a亚型89例(38.5%),不同基因型患者的性别分布差异有统计学意义(χ2=13.461,P=0.009);不同基因型患者间HCV RNA载量差异有统计学意义(F=3.176,P=0.034),其中1型的病毒载量明显高于2型和3型;不同基因型患者间肝病严重程度差异有统计学意义(P<0.001),1b型患者中进展为肝硬化和肝癌的比例高于其他基因型;基因型为2型的患者治疗后获得SVR率为93.1%,远高于1型患者的69.4%,差异有统计学意义(χ2=19.850,P<0001);112例(48.5%)患者出现了快速病毒学应答(RVR),其中96.4%最终产生SVR,未产生RVR的病例中64.7%最终产生SVR,两组SVR率比较差异有统计学意义(χ2=36.407,P<0.001);169例患者出现了完全早期病毒学应答(cEVR),其中88.8%最终产生SVR,未产生cEVR病例中56.5%最终产生了SVR,两组SVR率比较差异有统计学意义(χ2=29.684,P<0.001)。结论邢台地区丙型肝炎患者以1b亚型为主,其次为2a亚型。不同基因型患者性别、HCV RNA载量、SVR及肝病严重程度存在明显差异,丙型肝炎患者治疗前进行基因型分析对患者治疗、疾病进展以及预后有重要临床意义。RVR及cEVR等过程性病毒学应答指标对SVR有良好的指向性,产生这些病毒学应答的患者有较大概率获得SVR。
【Abstract】:ObjectiveTo analyze the distribution characteristics of hepatitis C virus (HCV) genotypes in Xingtai, China, and their relationship with disease progression and sustained virologic response (SVR), and to provide a basis for the prognostic judgment. MethodsA retrospective analysis was performed among 231 patients with hepatitis C who lived in Xingtai and were newly diagnosed and treated in our hospital from December 2010 to December 2014. In those patients, general information was collected, and alanine aminotransferase, aspartate aminotransferase, white blood cell, genotype, and viral load were determined. Continuous data were analyzed using analysis of variance, and categorical data were analyzed using χ2 test. ResultsIn all patients, patients with 1b subtype accounted for the highest proportion (n=109, 47.2%), followed by patients with 2a subtype (n=89, 38.5%). There was significant difference in gender distribution between patients with different genotypes (χ2=13.461, P=0.009). There was significant difference in HCV RNA load between patients with different genotypes (F=13.461, P=0.034). Particularly, patients with type 1 HCV had a significantly higher viral load than patients with type 2 or 3 HCV. There was also significant difference in severity of liver disease between patients with different genotypes (P<0.001). Particularly, the incidence rate of cirrhosis or liver cancer in patients with type 1b HCV was higher than that in patients with other genotypes. The incidence of SVR was significantly higher in patients with type 2 HCV than type 1 HCV (93.1% vs 69.4 %, χ2=19.850, P<0.001). In all patients, 112 (48.5%) had a rapid virologic response (RVR), and there was significant difference in the incidence of SVR between patients with and without a RVR (96.4% vs 64.7%, χ2=36.407, P<0.001). In all patients, 169 had a complete early virologic response (cEVR), and there was significant difference in the incidence of SVR between patients with and without a cEVR (88.8% vs 565%, χ2=29.684, P<0.001). ConclusionIn patients with HCV in Xingtai, 1b subtype accounts for the highest proportion, followed by 2a subtype. There are significant differences in sex, RNA viral load, SVR, and severity of liver disease between patients with different genotypes. An analysis of genotype before treatment is important for the treatment, disease progression, and prognosis of patients with HCV. RVR and cEVR well predict the incidence of SVR: patients with these virologic responses are likely to achieve a SVR.
【关键字】:肝炎,丙型;肝炎病毒属;基因型;持续病毒学应答;河北
【Key words】:hepatitis C; hepacivirus; gerotype; sustained virologic response; Hebei
【引证本文】:张彦芳, 赵冬梅, 张彦敏, 等. 邢台地区HCV基因型分布特征及其与疾病进展和持续病毒学应答的关系[J]. 临床肝胆病杂志, 2015, 31(11): 1845-1848.

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