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目的研究抚顺地区慢性丙型肝炎患者的基因分型与传播途径及个体化治疗的关系。方法选择2012年7月至2015年6月抚顺市传染病医院收治的236例明确诊断为慢性丙型肝炎患者,其中男性148例,女性88例;年龄8~83岁,平均年龄40.2岁。取其血清标本,提取丙型肝炎病毒(HCV)RNA,进行HCV基因分型,调查其传染途径,符合抗病毒指征者给予聚乙二醇干扰素(PEG-IFN)-α联合抗病毒药利巴韦林(RBV)治疗,观察应答相关指标。结果 236例慢性丙型肝炎患者中206例扩增成功,200例C区和NS5B区基因分型结果一致,检出基因型1a、1b、2a、3a、3b、6a、未分型,分别为6(3.00%)例、76(38.00%)例、81(40.50%)例、8(4.00%)例、15(7.50%)例、9(4.50%)例、5(2.50%)例;各HCV传播途径均有涉及,研究发现多以血液及血制品传播途径为主,为63.0%;静脉吸毒者所占比重为11%;6a型中静脉吸毒者为66.7%。治疗效果与基因型有关,不同基因型快速病毒学应答(RVR)、早期病毒学应答(EVR)、治疗结束时病毒学应答(ETVR)不尽相同,1b型的RVR为52.63%,低于2a、3a、3b、6a型的患者(P<0.05),与1a型患者的RVR差异无统计学意义(P>0.05)。各基因型获得的EVR无明显差异,1a、1b、3a型有1例、5例、1例未获得EVR,其余各基因型结束治疗的患者均获得ETVR。1b型的复发率大于2a型,分别为34.21%(26/76)及14.81%(12/81),两者间差异有统计学意义(P<0.05)。结论抚顺地区慢性丙型肝炎患者的基因分型包括1型、2型、3型、6型4种基因型和8种基因亚型,1b、2a两型居多,HCV各个传播途径均有涉及,1b型和2a型以血液及血制品传播为主,6a型中静脉吸毒者所占比重较多。并且不同基因型治疗效果不尽相同,因此应采取个体化的治疗方式。
Objective To study the relationship between genotyping and transmission of chronic hepatitis C patients and individualized treatment in Fushun area. Methods From July 2012 to June 2015, 236 cases of chronic hepatitis C were diagnosed in Fushun Infectious Diseases Hospital, including 148 males and 88 females, aged from 8 to 83 years with an average age of 40.2 years. Take the serum samples, extract the hepatitis C virus (HCV) RNA, HCV genotyping, investigate the route of transmission, in line with antiviral indications were given peginterferon (PEG-IFN) -a combined antiviral drugs Ribavirin (RBV) treatment, observation of response-related indicators. Results Of the 236 patients with chronic hepatitis C, 206 cases were successfully amplified. The genotyping results of 200 cases of C region and NS5B region were consistent. The genotypes 1a, 1b, 2a, 3a, 3b and 6a were genotyped (3.00%), 76 (38.00%), 81 (40.50%), 8 HCV transmission routes are involved, the study found that the majority of blood and blood products to the route of transmission, 63.0%; intravenous drug users accounted for 11%; 6a type drug users was 66.7%. The therapeutic effect was related to genotype. The rapid virological response (RVR), early virological response (EVR) and the virological response (ETVR) at the end of treatment were different for different genotypes. The type 1 b RVR was 52.63%, lower than 2a , 3a, 3b and 6a (P <0.05). There was no significant difference between RVR and type 1a patients (P> 0.05). There was no significant difference in EVR among all genotypes. There were 1 case of type 1a, 1b, 3a, 5 cases and 1 case of EVR. ETVR was obtained in the other genotypes. The recurrence rate of type 1b was higher than that of type 2a, which was 34.21% (26/76) and 14.81% (12/81), respectively. The difference was statistically significant (P <0.05). Conclusion The genotypes of patients with chronic hepatitis C in Fushun region include 4 genotypes 1, 2, 3 and 6 and 8 genotypes, most of which are in genotype 1b and 2a, and all of HCV transmission routes are involved. Type 1b and type 2a mainly spread blood and blood products, with a higher proportion of type 6a drug users. And the effects of different genotypes vary, so individualized treatment should be taken.