HBeAg阴性的慢性乙型肝炎和前C区变异的流行病学

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[B]
HBeAg阴性的慢性乙型肝炎和相关前核心区以及核心启动子变异的世界范围的流行病学 [/B]

2003-07-09


　　乙型肝炎是一种严重的疾病，在世界上许多地区流行。一部分慢性乙型肝炎（CHB）感染者由于感染了乙型肝炎病毒（HBV）的变异体而降低了或消除了乙型肝炎e抗原（HBeAg）。这次文献回顾的目的是描述全世界的HBeAg阴性的慢性乙型肝炎（e-CHB）的流行病学。文献的搜索是针对有关的e-CHB和潜在的变异体的研究（前核心区和核心启动子）。本分析中包括了五十个研究。在地中海地区慢性乙型肝炎感染的病人的e-CHB的中位流行率是33%。在亚太地区是15%。在美国和北欧是14%。前核心区阻断的密码子变异被检测到的总的HBeAg阴性的病人的中位数是60%（范围0-100%），92%在地中海地区，50%在亚太地区，24%在美国和北欧。几乎没有亚洲以外的核心启动子变异体流行的资料，在亚洲，HBeAg阴性病人的中位流行率是77%。本文献综述揭示了e-CHB比以前所怀疑的更常见并且是全世界现有的通过不同地区的相关HBV变异体流行的变异体标记物。在大量人群中使用足够大的样本进行附加研究以共同定义e-CHB，以及使用标准HBV DNA分析是能够更好地估计e-CHB的真正的流行率以及其相关的HBV变异体的流行率。

World-wide epidemiology of HBeAg-negative chronic hepatits B and associated precore and core promotor variants

SUMMARY. Hepatitis B is a serious disease that is endemic in many parts of the world. A signiÆcant proportion of patients with chronic hepatitis B (CHB) are infected with a variant form of the hepatitis B virus (HBV) which decreases or abolishes the production of hepatitis B e-antigen (HBeAg). The purpose of this literature review is to describe the epidemiology of HBeAg-negative CHB (e-CHB) worldwide. A literature search was conducted to identify studies pertaining to e-CHB and underlying variants (precore and core promoter). Fifty studies were included in our analysis. The median prevalence of e-CHB among patients with chronic HBV infection was 33% in the Mediterranean, 15% in Asia PaciÆc, and 14% in the USA and Northern Europe. The pre core stop codon variant was detected in a median of 60% (range 0±100%) of HBeAg-negative patients overall, 92% in the Mediterranean, 50% in Asia PaciÆc and 24% in the USA and Northern Europe. There were very few data on the prevalence of core promoter variants outside Asia where the median prevalence among HBeAg-negative patients was 77%. This literature review revealed that e-CHB is more common than previously suspected and that it is present worldwide with marked variations in the prevalence of associated HBV variants across different geographical regions. Additional research using population based samples of adequate size based on a consensus deÆnition of e-CHB and using standardized HBV DNA assays is needed to better estimate the true prevalence of e-CHB and its associated HBV variants.


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