中国慢性HBV感染者病毒基因型分布及其临床意义的Meta分析

发布时间：2018-09-06 07:42

【摘要】：研究背景乙型肝炎病毒(Hepatitis B virus,HBV)感染严重危害人类健康,随着人们对乙肝病毒认识的不断深入,乙肝病毒基因型的研究越来越受到人们重视,中国乙型肝炎病毒基因型在地理位置和人口学分布上也有明显差异,这可能与不同区域的人群,种族,乙肝病毒感染率及生活方式等相关,本文旨在探究乙型肝炎病毒基因型在中国不同地区和民族的分布特点,以及不同乙肝病毒基因型与不同肝病临床表现之间的联系,这项研究的发现有助于评估未来乙肝病毒感染的疾病负担,并且有助于发展乙肝病毒感染的控制措施。方法在万方数据库和NCBI数据库检索从2000年到2014年间有关中国HBV基因型分布的文章,根据严格的纳入和排除标准进行文献纳入,然后再按照地区、民族及感染类型的不同将不同基因型归类,最终应用Meta分析来研究中国基因型分布特点及其临床意义。结果在数据库检索出560篇有关乙肝病毒基因型的原始文献,经纳入排除标准后有220篇文献符合条件进行数据收集及数据统计,我们得知中国的HBV基因型主要以B基因型和C基因型为主,区域1(北部地区)HBV基因型A、B、C、B/C、D和其他型分别为0.1%、22.2%、69.1%、3.8%、0.5%和1.5%,其中C基因型比例显著高于其它区域(P0.05);区域2(中部地区)HBV基因型A、B、C、B/C、D和其他型分别为0.2%、62.6%、27.4%、3.8%、0.5%和2.4%,其中B基因型比例显著高于其它区域(P0.05);区域3(南部地区)HBV基因型A、B、C、B/C、D和其他型分别为0.6%、36.3%、49.4%、2.8%、2.6%和3.4%,其中C基因型比例显著高于区域2的27.4%(P0.05);区域4(青藏高原)感染HBV HBV基因型A、B、C、B/C、D和其他型分别为6.0%、22.5%、11.7%和59.3%,其中C/D混合型比例显著高于其他区域(P0.05)。不同民族的基因型分布也显著不同,藏族人群的C/D混合型比例(49.3%)显著高于其他民族(所有P0.05),哈萨克族的D基因型比例(58.1%)显著高于其他民族(所有P0.05)。此外,以慢性HBs Ag携带显的统计学差异。并且HBs Ag的水平随着疾者作为对照组,C基因型与慢性乙型肝炎、HBV相关性肝硬化、肝癌显著相关(ORs:1.979、3.888、4.399,所有P0.001)。结论中国主要基因型为B基因型和C基因型,不同地区和民族的HBV基因型分布也显著不同,中国南部地区和北部地区以C基因为主,中部地区以B基因型为主,并且本研究表明B基因型可能是中国乙型肝炎病毒的起源基因,同时本研究表明藏族人群中的乙肝病毒基因型以C/D混合型为主,回族和维吾尔族人群中的乙肝病毒基因型主要为C基因型和D基因型,D基因型主要分布于哈萨克族,另外,研究表明C基因型更有可能引起严重的肝损害,如肝硬化、肝细胞癌等。
[Abstract]:Background Hepatitis B virus (Hepatitis B virus,HBV) infection is a serious hazard to human health. With the deepening of people's understanding of hepatitis B virus, the study of hepatitis B virus genotypes has been paid more and more attention. There are also significant differences in geographic location and demographic distribution of hepatitis B virus genotypes in China, which may be related to population, race, HBV infection rate and lifestyle in different regions. The purpose of this study was to investigate the distribution of hepatitis B virus genotypes in different regions and nationalities in China, and the relationship between different hepatitis B virus genotypes and clinical manifestations of different liver diseases. The findings of the study help assess the future burden of hepatitis B infection and help develop control measures for hepatitis B infection. Methods articles on the distribution of HBV genotypes in China from 2000 to 2014 were searched in Wanfang database and NCBI database. The articles were included according to strict inclusion and exclusion criteria, and then by region. Different genotypes were classified in different ethnic groups and infection types. Finally, Meta analysis was used to study the distribution characteristics of Chinese genotypes and their clinical significance. Results 560 original literatures on HBV genotypes were retrieved from the database, 220 of which were eligible for data collection and statistics after inclusion of exclusion criteria. We know that the HBV genotypes in China are mainly genotype B and genotype C. In region 1 (northern region), the HBV genotypes AHB / C / C / C / D and others were 0.1% and 1.5%, respectively. The proportion of genotype C was significantly higher than that of other regions (P0.05); in region 2 (central region), the HBV genotypes of HBV were 0.22.627.4% and 2.4%, respectively, and the proportion of genotype B was significantly higher than that of other regions (P 0.05). The proportion of genotype B was significantly higher than that of other regions (P0.05), and the ratio of genotype B to genotype B was significantly higher than that of other regions (P0.05). The ratio of genotype B to genotype B was significantly higher than that of other regions (P0.05). The ratio of genotype B to genotype B was 0.5% and 2.4%, respectively. The ratio of genotype C was significantly higher than that of other regions (P0.05); the proportion of genotype C of region 3 (southern region) was significantly higher than that of region 2 (P 0.05); the proportion of genotype C of region 3 (Qinghai-Xizang plateau) infected with HBV HBV genotype ABBU / C / C was 0.6% and 3.44%, respectively. The percentage of genotype C was significantly higher than that of region 2 (P0.05); the proportion of region 4 (Qinghai-Tibet Plateau) infected with HBV HBV genotype ABBCU / C / C and other types was higher than that of region 2 (P0.05); the percentage of genotype C was significantly higher than that of region 2 (P0.05); The ratio of C / D mixed type was significantly higher than that of other regions (P0.05). The proportion of C / D mixed genotype of Tibetan population (49.3%) was significantly higher than that of other ethnic groups (all P0.05), and that of Kazak nationality (58.1%) was significantly higher than that of other ethnic groups (all P0.05). In addition, there was significant statistical difference in chronic HBs Ag carriers. The level of HBs Ag was significantly correlated with chronic hepatitis B associated cirrhosis and liver cancer (ORs:1.979,3.888,4.399, all P 0.001). Conclusion the main genotypes in China are genotype B and genotype C, and the distribution of HBV genotypes in different regions and nationalities is also significantly different. C gene is dominant in the southern and northern regions of China, and genotype B in the central part of China. This study suggests that genotype B may be the origin gene of hepatitis B virus in China, and the genotype of hepatitis B virus in Tibetan population is mainly composed of C / D mixed genotype. In the Hui and Uygur population, hepatitis B virus genotype C and D genotype are mainly distributed in Kazak nationality. In addition, studies show that genotype C is more likely to cause severe liver damage, such as liver cirrhosis. Hepatocellular carcinoma, etc.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.62

【参考文献】