Abstract:

Abstrct：ObjectiveTo study relationship between genotype of hepatitis B virus and clinical classification in chidren with chronic hepatitis B in Gansu province. MethodsTotally 124 HBV-DNA positive chidren with chronic hepatitis B were randomly enrolled，84 of whom were males and 40 were females. Among 124 patients，there were 65 cases of HBV carriers，chronic hepatitis （mild in 31 cases，18 cases of moderate and severe in 10 cases）. The genotypes of their serum HBV，liver function，preoperative blood coagulation and HBV-DNA load were detected. ResultsAmong the serum samples of 124 cases，C genotype existed in 62 cases（50.0％），B in 48 cases（38.7％），B/C in 9 cases（7.3％）， non B/C in 5 cases（4.0％）. In HBV carriers and mild group，the Bgenotype was 47.7% and 45.2% respectively，while in moderate and severe group，the C genotype was 72.2% and 80% respectively. As for B and C genotype distribution，there was significante difference between HBV carriers and mild group and moderate and severe group； DNA，ALT，AST and TBIL in C genotypes were higher than B. Compared with patients with genotype B，PT grolonged and PTA and FIB decreased in Cgenotype patients，the difference being significant. In genotype B and C，the ratio of mother to child transmission had no significant difference. ConclusionGenotype C and B HBV are mainly found in chidren with chronic hepatitis B in Gansu province，and genotype C is predominant. The liver pathological damage levels of genotype C in chidren with chronic hepatitis B is more serious ，and the viral load is higher than that of genotype B. Detection of Hepatitis B virus genotypes is of great importance in guiding therapy，assessment of prognosis and early prevention.

Key words: hepatitis B virus, genotype, clinical classification

摘要：

目的了解儿童乙型肝炎病毒（HBV）基因型与临床分度的关系。方法选择甘肃省人民医院儿科和兰州大学第一医院感染科2008年4月至2010年4月门诊和住院患儿中HBV-DNA阳性的124例乙型肝炎患儿，其中男84例，女40例。HBV携带者65例，慢性乙型肝炎59例（轻度31例、中度18例、重度10例），对以上患儿进行基因分型、同时检测肝功、术前出凝血、HBV-DNA载量。结果124例肝病患儿中，C基因型62例（50.0%），B基因型48例（38.7%），B/C混合型9例（7.3%），非B/C型5例（4.0%）；HBV携带者和轻度组中，以B基因型为主，分别为47.7%和45.2%；中度和重度组中，以C基因型为主，分别为72.2%和80%；在C、B基因型分布方面，HBV携带者和轻度组与中度和重度组比较差异有统计学意义； C基因型患者的HBV-DNA载量、丙氨酸转氨酶（ALT）、天冬氨酸转移酶（AST）、总胆红素（TBIL）均高于B基因型 ；C基因型患者与B基因型比较，凝血酶原时间（PT）延长、凝血酶原活动度（PTA）下降、纤维蛋白原（FIB）减少。B、C型通过母婴传播的比例差异无统计学意义。结论甘肃省儿童乙型肝炎病毒基因型以C、B型为主，以C基因型为优势。C基因型患儿的肝功损害较B基因型严重且病毒载量也高。儿童乙肝病毒基因型的检测对指导治疗、评估预后及早期预防具有非常重要的意义。

关键词: 乙型肝炎病毒, 基因型, 临床分度