[AASLD 2012]中国大陆HCV流行趋势

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美国肝病研究学会（AASLD）第63届年会上，来自北京地坛医院成军教授等开展的一项研究揭示了中国大陆丙型肝炎病毒（HCV）流行趋势。



       丙型肝炎病毒基因型的测定对预测抗病毒治疗应答以及治疗时间是非常重要的。

       该项研究共搜集了853个的HCV RNA阳性血清样本，这些血清样本来自2009年10月至2011年6月，中国大陆23个单位慢性丙型肝炎病毒感染患者。

       研究结果揭示了中国大陆HCV感染的新趋势：中国大陆HCV流行基因型主要为1，2，3和6型，没有发现4和5基因型。中国大陆地区最常见的基因型为1b和2a，流行率为73.1%和18.5%，其次为3a，6a，3b，6n和1a。基因3型和6型的地理分布越来越广。1b和2a型患者年龄偏大，最主要的传播途径为输血传播。

研究论文摘要

Wei Ju1, Song Yang1, Qi Wang1, Huichun Xing1, Yao Xie2, Wen Xie2, Jun Cheng1; 1Beijing Ditan Hospital Capital Medical University,Beijing, China; 2Beijing Ditan Hospital,Beijing, China

Determination of HCV genotype is significant for the prediction of response to anti-viral therapy and duration of treatment. This is an epidemiological study of patients infected chronically with HCV in mainland China. A total of 853 HCV RNA positive serum samples were collected from chronic HCV infected patients from 23 administrative units in mainland China during 2009.10 - 2011.6.

The serum samples were subjected to RTPCR followed by direct DNA sequencing and phylogenetic analysis of NS5B and/or CORE-E1 regions. HCV genotypes were available in 811 samples [95.1% (811/853)]. The results indicated new trends of HCV infection in mainland China. Phylogenetic analysis revealed that genotype 1, 2, 3 and 6 were detected. No genotype 4 and 5 strains were found.

The distribution of HCV subtypes was 1b, 2a, 3a, 6a, 3b, 6n, and 1a at frequencies of 73.1%, 18.5%, 3.2%, 2.5%, 1.8%, 0.5%, and 0.4%, respectively. HCV subtype 1b was the most frequent in mainland China followed by 2a. The HCV genotype distribution differed according to the patients’ region of origin and genotypes 3 and 6 represented an increasingly wide range of geographic distribution. Patients infected with HCV subtype 1b and 2a were found statistically older than those infected with 3a, 3b, 6a and 6n, respectively. Blood transfusion was the main route of transmission. IDUs and tattooing / piercing were more common among patients with genotype 3 compared with those with genotype 1.

This study is the largest report of molecular epidemiology of HCV in mainland China and demonstrates a genetic heterogeneity of HCV infection, with at least four HCV genotypes and seven subtypes. Clinical trials of direct anti-HCV agents (DAA) should consider this genetic heterogeneity.