丙型肝炎病毒自发清除及肝纤维化进展的影响因素

发布时间：2018-01-17 12:52

本文关键词：丙型肝炎病毒自发清除及肝纤维化进展的影响因素　出处：《吉林大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：丙型肝炎是一种呈世界性分布的疾病，，全球HCV感染率为2.2-3.0%，我国HCV感染率约为3.2%。人感染HCV后，约15%～45%的感染者可以自发清除病毒，其余55%～85%感染者进展成为慢性感染者。HCV慢性感染，可导致肝脏慢性炎症反应、坏死和纤维化，甚至肝硬化，肝癌。由于丙型肝炎发病隐匿，自然史不明，本文从宿主、病毒、环境三个方面对丙型肝炎病毒感染后病毒自发清除，及HCV慢性感染后肝脏炎性损伤及肝纤维化进程进行分析，试图探寻丙肝病毒感染后自然演变过程的影响因素，为丙肝自然史的研究提供新的证据。方法：回顾性分析92例HCV自发清除者和487例HCV慢性感染者病史资料，所有患者均接受统一问卷调查，进行血常规、肝功能、肝纤维化及IL28B rs12979860位点基因多态性检测。采用单因素和多因素Logistic回归分析方法探讨丙肝病毒自发清除及HCV慢性感染后肝脏炎性损伤及肝纤维化进程的影响因素。结果：1、比较92例丙肝病毒自发清除者及312例丙肝慢性感染者的基本特征及病史资料，在单因素分析中，女性（P=0.001）、黄疸性肝炎史（P=0.001）、合并乙肝感染（P＜0.001），IL28B12979860位点CC基因型（P＜0.022）与HCV自发清除呈正相关，而饮酒史与HCV自发清除呈负相关（P=0.006）；经多因素分析调整相关影响因素后，仅女性（OR=2.42,95%CI:1.23-4.75）、黄疸性肝炎史（OR=3.03,95%CI:1.47-6.25）、现合并乙肝感染（OR=6.02,95%CI:2.37-15.31），IL28B rs12979860位点CC基因型（OR=3.23,95%CI:1.09-9.55）成为促进影响丙肝病毒自发清除的独立影响因素。2、比较92例丙肝病毒自发清除者及487例丙肝慢性感染者临床特征，丙肝病毒自发清除组患者血小板平均值明显高于慢性感染组（211.6×109/L vs178.3×109/L, P0.001),但两组血小板异常率无显著性差异。慢性感染组ALT、AST、GGT平均值及异常率均高于HCV自发清除组（P0.001）,慢性感染组平均肝纤维化程度高于自发清除组（FibroScan评分：7.3vs5.8，P0.001）,且慢性感染组较自发清除组更容易发生肝纤维化异常（50.2%vs16.3%，P0.001）。3、分析487例慢丙肝患者ALT、AST异常的影响因素，在单因素分析中，ALT异常组平均年龄明显高于ALT正常组（52.1vs50.2，P0.05），饮酒和黄疸型肝炎史与ALT和AST异常的呈正相关（P0.05），而女性则与ALT和AST异常呈负相关（P0.05），丙肝病毒1b基因型和HCV RNA4×105IU/ml与AST异常呈正相关（P0.05）；经多因素分析，仅性别（OR=3.23,95%CI:1.51-6.91）成为影响ALT异常的独立影响因素，HCV RNA病毒定量4×105IU/ml（OR=2.28,95%CI:1.50-3.47）和HCV RNA基因型1b（OR=2.06,95%CI:1.40-3.05）成为促进AST异常的独立影响因素。4、分析484例慢丙肝患者，高年龄（OR=1.78,95%CI:1.08-2.94）和现合并乙肝感染（OR=3.13,95%CI:1.12-8.71）是肝纤维化≥F3期的促进因素。结论：1、女性、黄疸性肝炎史、合并乙肝感染及IL28B rs12979860位点CC基因型是丙肝病毒自发清除的保护性因素。2、丙肝病毒自发清除者较HCV慢性感染者肝功能损伤程度轻。3、丙肝病毒定量4×105IU/ml和HCVRNA1b基因型是慢性HCV感染者AST异常的独立影响因素，而女性则是慢性HCV感染者ALT异常的独立影响因素。4、高龄和现合并乙肝感染是慢性HCV感染者发生严重肝纤维化的独立危险因素。
[Abstract]:Objective: hepatitis C is a worldwide disease, the infection rate of global HCV 2.2-3.0%, at a rate of about 3.2%. people infected with HCV HCV infections in China, about 15% to 45% of those infected can spontaneously clear the virus, the remaining 55% to 85% infected patients progress to chronic.HCV infections can cause chronic infections. The chronic liver inflammation, necrosis and fibrosis, cirrhosis, hepatocellular carcinoma. The incidence of occult hepatitis C, natural history is unknown, this paper from the three aspects of host, virus, virus of hepatitis C virus infection after spontaneous clearance, and analysis of chronic HCV infection after liver inflammation and liver fibrosis, attempts to explore the influence factors hepatitis C virus infection after the natural evolution process, provide new evidence on the natural history of HCV infection.
Methods: a retrospective analysis of 92 cases of spontaneous clearance of HCV and 487 cases of chronic HCV infection clinical data, all patients received questionnaire, blood routine, liver function, hepatic fibrosis and IL28B rs12979860 polymorphism detected by univariate and multivariate Logistic regression analysis method to investigate the effect of hepatitis C virus and chronic spontaneous clearance HCV after infection, hepatic inflammation and liver fibrosis factors.
Results: 1, the basic characteristics and clinical data of 92 cases of hepatitis C virus compared with spontaneous clearance patients and 312 cases of chronic hepatitis C infection, in univariate analysis, female (P=0.001), jaundice hepatitis history (P=0.001), with hepatitis B infection (P < 0.001), IL28B12979860 site CC genotype (P < 0.022) HCV was positively associated with spontaneous clearance, and drinking history and spontaneous clearance of HCV was negatively correlated (P=0.006); multivariate analysis adjusted related factors, only women (OR=2.42,95%CI:1.23-4.75), jaundice hepatitis history (OR=3.03,95%CI:1.47-6.25), now with hepatitis B infection (OR=6.02,95%CI:2.37-15.31), IL28B rs12979860 CC genotype (OR=3.23,95%CI:1.09-9.55) as.2 the independent factors to promote the effect of HCV spontaneous clearance, 92 cases of hepatitis C virus and spontaneous clearance of clinical features of 487 cases of hepatitis C chronic hepatitis C virus infection and spontaneous clearance patients in blood In the average value was higher than that in chronic infection group (211.6 109/L * vs178.3 * 109/L, P0.001), but the two groups had no significant difference between the rate of abnormal platelet. Chronic infection group, ALT, AST, GGT average value and the abnormal rate was higher than that of HCV group (P0.001), spontaneous clearance of chronic infection group was significantly higher than that of the average liver fiber spontaneous clearance group (FibroScan score: 7.3vs5.8, P0.001), and chronic infection group than in the spontaneous clearance group are more likely to have abnormal liver fibrosis (50.2%vs16.3%, P0.001).3, analysis of 487 cases of patients with chronic hepatitis C ALT, influencing factors of abnormal AST, in univariate analysis, abnormal ALT group were significantly older than that of normal group (52.1vs50.2, ALT P0.05), drinking and icteric hepatitis history with ALT and abnormal AST were positively correlated (P0.05), while women with ALT and abnormal AST were negatively correlated (P0.05), hepatitis C virus related 1B gene and HCV RNA4 * 105IU/ml and AST positive anomaly (P0.05); multi factor Analysis of gender (OR=3.23,95%CI:1.51-6.91), only become independent factors affecting ALT anomaly, HCV RNA virus quantitative 4 * 105IU/ml (OR=2.28,95%CI:1.50-3.47) and HCV RNA genotype 1b (OR=2.06,95%CI:1.40-3.05).4 become the promotion of independent factors of abnormal AST, analysis of 484 Cases of patients with chronic hepatitis C, high age (OR=1.78,95%CI:1.08-2.94) and OR=3.13,95%CI:1.12-8.71 (combined with hepatitis B infection) is to promote the F3 phase of liver fibrosis and above.
Conclusion: 1, female, jaundice hepatitis history, with hepatitis B infection and IL28B rs12979860 CC genotype is a protective factor for HCV spontaneous clearance of.2, HCV spontaneous clearance than chronic HCV infection degree of liver injury in hepatitis C virus quantitative light.3, 4 * 105IU/ml and HCVRNA1b genotype were independent factors of AST abnormality chronic HCV infection, and the female is.4 independent factors of abnormal ALT in chronic HCV infection, and the elderly with hepatitis B infection is an independent risk factor of chronic HCV infection of severe hepatic fibrosis.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R512.63

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