西藏自治区某医院体检人群乙型肝炎病毒感染状况及病毒S区氨基酸变异特征分析

徐琳莉; 袁筱婕; 张维璐; 李红燕; 吉兆华; 王玉华; 李怡君; 王月梅; 邵中军

doi:10.16462/j.cnki.zhjbkz.2024.11.005

西藏自治区某医院体检人群乙型肝炎病毒感染状况及病毒S区氨基酸变异特征分析

doi: 10.16462/j.cnki.zhjbkz.2024.11.005

1.
第四军医大学预防医学系流行病学教研室，特殊作业环境危害评估与防治教育部重点实验室，西安 710032
2.
西藏大学附属阜康医院，拉萨 850000

基金项目:

陕西省自然科学基础研究计划资助项目 2023-JC-QN-0987

详细信息

通讯作者:
邵中军，E-mail: 13759981783@163.com

中图分类号: R183
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- 被引次数: 0
出版历程
- 收稿日期: 2024-06-12
- 修回日期: 2024-09-09
- 网络出版日期: 2024-12-23
- 刊出日期: 2024-11-10

Characterization of hepatitis B virus infection status and amino acid variations in the S region of the virus in a hospital population undergoing physical examination in Tibet

1.
Department of Epidemiology, School of Public Health, Fourth Military Medical University, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Xi′an 710032, China
2.
Fukang Hospital Affiliated to Tibet University, Lhasa 850000, China

Funds:

Natural Science Basic Research Program of Shaanxi 2023-JC-QN-0987

More Information

Corresponding author: SHAO Zhongjun, E-mail: 13759981783@163.com

摘要

摘要: 目的描述西藏自治区某医院体检人群乙型肝炎病毒(hepatitis B virus, HBV)感染状况，分析HBV基因型分布特征和S区氨基酸变异特点。方法选择2022年5月―2023年7月在西藏自治区某医院的健康体检人群作为研究对象，采用随机抽样方法对体检人群进行问卷调查和血清学检测。根据乙型病毒性肝炎(简称乙肝)血清标志物检测结果，对乙型肝炎表面抗原(hepatitis B surface antigen, HBsAg)、乙型肝炎e抗原(hepatitis B e antigen, HBeAg)、乙型肝炎核心抗体(hepatitis B core antibody, 抗-HBc)阳性样本进行S区基因扩增及氨基酸变异分析。结果共纳入3 970名研究对象，乙肝血清标志物检测结果显示，HBsAg、乙型肝炎表面抗体(antibody to hepatitis B surface antigen, 抗-HBs)和抗-HBc共检出8种血清标志物组合模式。HBV感染率和单项抗-HBc阳性率在不同年龄、性别、职业、婚姻状况和地区之间差异均有统计学意义(均P < 0.001)。48例样本扩增出S区序列，分型结果显示D型39例、C型8例和B型1例，其中13例在S区的主要亲水区(major hydrophilic region, MHR)发生氨基酸突变。结论西藏自治区为乙肝高流行地区，HBV基因型主要是D型，HBV S区的MHR氨基酸序列存在多个位点的变异，需积极开展成人的乙型肝炎疫苗防疫措施。
- 乙型肝炎病毒 /
- 血清学模式 /
- 变异分析
Abstract: Objective To probe the status of hepatitis B virus infection in the physical examination population of the Tibet Autonomous Region and to clarify the distribution characteristics of hepatitis B virus genotypes and the amino acid variants in the S region. Methods The health check-up population in a hospital in Tibet from May 2022 to July 2023 was selected as the study population, and questionnaires and serologic tests were conducted on the check-up population using random sampling method. According to the results of hepatitis B serologic markers, hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), hepatitis B core antibody (anti-HBc) positive samples were subjected to S region gene amplification and amino acid variation analysis. Results A total of 3 970 medical examiners were included, and eight combinations of serum markers were detected for HBsAg, antibody to hepatitis B surface antigen (anti-HBs), and anti-HBc. Differences in the prevalence of HBV infection and the positive rate of single anti-HBc were statistically significant across varing groups including age, gender, occupation, marital status and region (all P < 0.001). The S region sequences were amplified from 48 samples, and the typing results were 39 cases of genotype D, 8 cases of genotype C and 1 case of genotype B, of which 13 cases had amino acid mutations in the major hydrophilic region (MHR) of the S genetic region. Conclusions The Tibet Autonomous Region is a highly endemic area for hepatitis B. The HBV genotype is mainly genotype D and the amino acid sequence of the major hydrophilic region in the S region of HBV has mutations at several sites, so it is necessary to actively carry out vaccination measures against hepatitis B in adults.
- Hepatitis B virus /
- Serological pattern /
- Variation analysis

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图 1 西藏自治区不同地区的体检人群HBsAg阳性率、HBV感染率和单项抗-HBs阳性率情况

Figure 1. HBsAg positivity rate, HBV infection rate, and Anti-HBs positivity single rate among physical examination populations in different regions of the Tibet

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表 1 三项乙型病毒性肝炎血清标志物检出模式

Table 1. Detection patterns of three hepatitis B serological markers

模式 Pattern	HBsAg	抗-HBs Anti-HBs	抗-HBc Anti-HBc	例数 Case	占比/% Proportion/%
1	-	+	-	1 112	28.01
2	-	-	-	1 002	25.24
3	-	+	+	885	22.29
4	+	-	+	498	12.54
5	-	-	+	394	9.92
6	+	+	+	41	1.03
7	+	-	-	26	0.65
8	+	+	-	12	0.03

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表 2 西藏自治区体检人群HBsAg阳性、HBV感染和单项抗-HBs情况

Table 2. HBsAg positivity, HBV infection, and anti-HBs positivity single among the physical examination population in the Tibet

变量 Variable	调查人数 Number of observers	HBsAg阳性 HBsAg positive			HBV感染^③ HBV infection			单项抗-HBs阳性 Anti-HBs positivity single
变量 Variable	调查人数 Number of observers	阳性人数 Number of positives^②	χ²值 value	P值 value	感染人数 Number of infections^②	χ²值 value	P值 value	阳性人数 Number of positives^②	χ²值 value	P值 value
性别 Gender			3.07	0.086		1.38	0.240		9.09	0.003
男性 Male	2 151	332(15.43)			1 024(47.61)			560(26.03)
女性 Female	1 819	245(13.47)			832(45.74)			552(30.35)
年龄组/岁 Age group/years			2.91	0.741		83.99	< 0.001		78.62	< 0.001
< 18	27	3(11.11)			15(55.56)			6(22.22)
18~＜30	906	122(13.47)			328(36.20)			333(36.75)
30~＜40	1 529	216(14.13)			690(45.13)			445(29.10)
40~＜50	805	128(15.90)			421(52.30)			207(25.71)
50~＜60	478	74(15.48)			277(57.95)			80(16.74)
≥60	225	34(15.11)			125(55.56)			41(18.22)
民族 Ethnic group			3.99	0.142		28.23	< 0.001		38.20	< 0.001
汉族 Han	813	101(12.42)			314(38.62)			298(36.65)
藏族 Tibetan	3 138	474(15.11)			1 535(48.92)			808(25.75)
其他 Others	19	2(10.53)			7(36.84)			6(31.58)
职业 Occupation			8.86	0.115		24.57	< 0.001		43.52	< 0.001
学生 Student	54	8(14.81)			14(25.93)			23(42.59)
牧民 Herdsman	37	6(16.22)			22(59.46)			8(21.62)
农民 Peasantry	427	76(17.80)			228(53.40)			68(15.93)
职工 Staff	3 278	457(13.94)			1 499(45.73)			971(29.62)
工人 Worker	37	3(8.11)			22(59.46)			7(18.92)
其他 Others	137	27(19.71)			71(51.82)			35(25.55)
婚姻状况 Marital status			5.23	0.073		56.72	< 0.001		42.59	< 0.001
已婚 Married	2 983	449(15.05)			1 489(49.92)			757(25.38)
未婚 Unmarried	896	111(12.39)			320(35.71)			327(36.05)
其他 Others^①	91	17(18.68)			47(51.65)			28(30.77)
合计 Total	3 970	577(14.53)			1 856(46.75)			1 112(28.01)
注：①包括离异、丧偶和缺失数据；②以人数(占比/%)表示；③HBsAg、抗-HBc中有一项或一项以上为阳性。 Note: ① Includes divorced, widowed, and missing data; ② Number of people (proportion/%); ③ Positivity in one or more HBsAg or anti-HBc.

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表 3 主要亲水区域氨基酸突变情况

Table 3. Amino acid mutations in the major hydrophilic region

样本编号 Sample number	基因型 Genotype	主要亲水区域氨基酸突变情况 Amino acid mutations in the major hydrophilic region
S2	D	sI110L sT118A
S6	D	sV106G
S7	D	sT118A
S9	D	sT118A
S13	D	sT118A
S16	D	sT118A
S21	D	sT118A
S23	D	sT118A
S25	D	sT118A
S26	D	sT118A
S32	D	sS143T
S41	D	sS143L
S44	D	sT131N sY134N

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