本文關(guān)鍵詞：丙型肝炎病毒自發(fā)清除及肝纖維化進(jìn)展的影響因素　出處：《吉林大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

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【摘要】：目的：丙型肝炎是一種呈世界性分布的疾病，，全球HCV感染率為2.2-3.0%，我國(guó)HCV感染率約為3.2%。人感染HCV后，約15%～45%的感染者可以自發(fā)清除病毒，其余55%～85%感染者進(jìn)展成為慢性感染者。HCV慢性感染，可導(dǎo)致肝臟慢性炎癥反應(yīng)、壞死和纖維化，甚至肝硬化，肝癌。由于丙型肝炎發(fā)病隱匿，自然史不明，本文從宿主、病毒、環(huán)境三個(gè)方面對(duì)丙型肝炎病毒感染后病毒自發(fā)清除，及HCV慢性感染后肝臟炎性損傷及肝纖維化進(jìn)程進(jìn)行分析，試圖探尋丙肝病毒感染后自然演變過程的影響因素，為丙肝自然史的研究提供新的證據(jù)。 方法：回顧性分析92例HCV自發(fā)清除者和487例HCV慢性感染者病史資料，所有患者均接受統(tǒng)一問卷調(diào)查，進(jìn)行血常規(guī)、肝功能、肝纖維化及IL28B rs12979860位點(diǎn)基因多態(tài)性檢測(cè)。采用單因素和多因素Logistic回歸分析方法探討丙肝病毒自發(fā)清除及HCV慢性感染后肝臟炎性損傷及肝纖維化進(jìn)程的影響因素。 結(jié)果：1、比較92例丙肝病毒自發(fā)清除者及312例丙肝慢性感染者的基本特征及病史資料，在單因素分析中，女性（P=0.001）、黃疸性肝炎史（P=0.001）、合并乙肝感染（P＜0.001），IL28B12979860位點(diǎn)CC基因型（P＜0.022）與HCV自發(fā)清除呈正相關(guān)，而飲酒史與HCV自發(fā)清除呈負(fù)相關(guān)（P=0.006）；經(jīng)多因素分析調(diào)整相關(guān)影響因素后，僅女性（OR=2.42,95%CI:1.23-4.75）、黃疸性肝炎史（OR=3.03,95%CI:1.47-6.25）、現(xiàn)合并乙肝感染（OR=6.02,95%CI:2.37-15.31），IL28B rs12979860位點(diǎn)CC基因型（OR=3.23,95%CI:1.09-9.55）成為促進(jìn)影響丙肝病毒自發(fā)清除的獨(dú)立影響因素。2、比較92例丙肝病毒自發(fā)清除者及487例丙肝慢性感染者臨床特征，丙肝病毒自發(fā)清除組患者血小板平均值明顯高于慢性感染組（211.6×109/L vs178.3×109/L, P0.001),但兩組血小板異常率無顯著性差異。慢性感染組ALT、AST、GGT平均值及異常率均高于HCV自發(fā)清除組（P0.001）,慢性感染組平均肝纖維化程度高于自發(fā)清除組（FibroScan評(píng)分：7.3vs5.8，P0.001）,且慢性感染組較自發(fā)清除組更容易發(fā)生肝纖維化異常（50.2%vs16.3%，P0.001）。3、分析487例慢丙肝患者ALT、AST異常的影響因素，在單因素分析中，ALT異常組平均年齡明顯高于ALT正常組（52.1vs50.2，P0.05），飲酒和黃疸型肝炎史與ALT和AST異常的呈正相關(guān)（P0.05），而女性則與ALT和AST異常呈負(fù)相關(guān)（P0.05），丙肝病毒1b基因型和HCV RNA4×105IU/ml與AST異常呈正相關(guān)（P0.05）；經(jīng)多因素分析，僅性別（OR=3.23,95%CI:1.51-6.91）成為影響ALT異常的獨(dú)立影響因素，HCV RNA病毒定量4×105IU/ml（OR=2.28,95%CI:1.50-3.47）和HCV RNA基因型1b（OR=2.06,95%CI:1.40-3.05）成為促進(jìn)AST異常的獨(dú)立影響因素。4、分析484例慢丙肝患者，高年齡（OR=1.78,95%CI:1.08-2.94）和現(xiàn)合并乙肝感染（OR=3.13,95%CI:1.12-8.71）是肝纖維化≥F3期的促進(jìn)因素。 結(jié)論：1、女性、黃疸性肝炎史、合并乙肝感染及IL28B rs12979860位點(diǎn)CC基因型是丙肝病毒自發(fā)清除的保護(hù)性因素。2、丙肝病毒自發(fā)清除者較HCV慢性感染者肝功能損傷程度輕。3、丙肝病毒定量4×105IU/ml和HCVRNA1b基因型是慢性HCV感染者AST異常的獨(dú)立影響因素，而女性則是慢性HCV感染者ALT異常的獨(dú)立影響因素。4、高齡和現(xiàn)合并乙肝感染是慢性HCV感染者發(fā)生嚴(yán)重肝纖維化的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective: hepatitis C is a worldwide disease, the infection rate of global HCV 2.2-3.0%, at a rate of about 3.2%. people infected with HCV HCV infections in China, about 15% to 45% of those infected can spontaneously clear the virus, the remaining 55% to 85% infected patients progress to chronic.HCV infections can cause chronic infections. The chronic liver inflammation, necrosis and fibrosis, cirrhosis, hepatocellular carcinoma. The incidence of occult hepatitis C, natural history is unknown, this paper from the three aspects of host, virus, virus of hepatitis C virus infection after spontaneous clearance, and analysis of chronic HCV infection after liver inflammation and liver fibrosis, attempts to explore the influence factors hepatitis C virus infection after the natural evolution process, provide new evidence on the natural history of HCV infection.
Methods: a retrospective analysis of 92 cases of spontaneous clearance of HCV and 487 cases of chronic HCV infection clinical data, all patients received questionnaire, blood routine, liver function, hepatic fibrosis and IL28B rs12979860 polymorphism detected by univariate and multivariate Logistic regression analysis method to investigate the effect of hepatitis C virus and chronic spontaneous clearance HCV after infection, hepatic inflammation and liver fibrosis factors.
Results: 1, the basic characteristics and clinical data of 92 cases of hepatitis C virus compared with spontaneous clearance patients and 312 cases of chronic hepatitis C infection, in univariate analysis, female (P=0.001), jaundice hepatitis history (P=0.001), with hepatitis B infection (P < 0.001), IL28B12979860 site CC genotype (P < 0.022) HCV was positively associated with spontaneous clearance, and drinking history and spontaneous clearance of HCV was negatively correlated (P=0.006); multivariate analysis adjusted related factors, only women (OR=2.42,95%CI:1.23-4.75), jaundice hepatitis history (OR=3.03,95%CI:1.47-6.25), now with hepatitis B infection (OR=6.02,95%CI:2.37-15.31), IL28B rs12979860 CC genotype (OR=3.23,95%CI:1.09-9.55) as.2 the independent factors to promote the effect of HCV spontaneous clearance, 92 cases of hepatitis C virus and spontaneous clearance of clinical features of 487 cases of hepatitis C chronic hepatitis C virus infection and spontaneous clearance patients in blood In the average value was higher than that in chronic infection group (211.6 109/L * vs178.3 * 109/L, P0.001), but the two groups had no significant difference between the rate of abnormal platelet. Chronic infection group, ALT, AST, GGT average value and the abnormal rate was higher than that of HCV group (P0.001), spontaneous clearance of chronic infection group was significantly higher than that of the average liver fiber spontaneous clearance group (FibroScan score: 7.3vs5.8, P0.001), and chronic infection group than in the spontaneous clearance group are more likely to have abnormal liver fibrosis (50.2%vs16.3%, P0.001).3, analysis of 487 cases of patients with chronic hepatitis C ALT, influencing factors of abnormal AST, in univariate analysis, abnormal ALT group were significantly older than that of normal group (52.1vs50.2, ALT P0.05), drinking and icteric hepatitis history with ALT and abnormal AST were positively correlated (P0.05), while women with ALT and abnormal AST were negatively correlated (P0.05), hepatitis C virus related 1B gene and HCV RNA4 * 105IU/ml and AST positive anomaly (P0.05); multi factor Analysis of gender (OR=3.23,95%CI:1.51-6.91), only become independent factors affecting ALT anomaly, HCV RNA virus quantitative 4 * 105IU/ml (OR=2.28,95%CI:1.50-3.47) and HCV RNA genotype 1b (OR=2.06,95%CI:1.40-3.05).4 become the promotion of independent factors of abnormal AST, analysis of 484 Cases of patients with chronic hepatitis C, high age (OR=1.78,95%CI:1.08-2.94) and OR=3.13,95%CI:1.12-8.71 (combined with hepatitis B infection) is to promote the F3 phase of liver fibrosis and above.
Conclusion: 1, female, jaundice hepatitis history, with hepatitis B infection and IL28B rs12979860 CC genotype is a protective factor for HCV spontaneous clearance of.2, HCV spontaneous clearance than chronic HCV infection degree of liver injury in hepatitis C virus quantitative light.3, 4 * 105IU/ml and HCVRNA1b genotype were independent factors of AST abnormality chronic HCV infection, and the female is.4 independent factors of abnormal ALT in chronic HCV infection, and the elderly with hepatitis B infection is an independent risk factor of chronic HCV infection of severe hepatic fibrosis.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R512.63

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