云南大理地區(qū)丙型肝炎病毒基因分型及合并HIV感染后血細(xì)胞和生化指標(biāo)變化的研究
發(fā)布時(shí)間：2018-07-17 02:21
【摘要】：目的 首先對(duì)2008年采集自大理州人民醫(yī)院13例HIV合并丙型肝炎患者進(jìn)行丙型肝炎病毒(HCV)基因分型研究,為丙型病毒性肝炎診斷、治療、預(yù)后以及追溯傳染源和傳播途徑的提供科學(xué)基礎(chǔ)；其次對(duì)大理地區(qū)單純性HCV感染和HCV合并HIV感染患者血細(xì)胞和生化指標(biāo)進(jìn)行分析,為單純性HCV感染和合并HIV感染患者的診斷和治療提供依據(jù)。 方法 采用型特異性引物進(jìn)行巢式RT-PCR擴(kuò)增,PCR產(chǎn)物直接測(cè)序,采用生物信息學(xué)軟件進(jìn)行序列分析；收集2013年1月-9月期間就診于大理州人民醫(yī)院門診和住院臨床診斷為單純性HCV感染病例、HCV合并HIV感染病例以及排除HCV和HIV感染病例的基本信息、血細(xì)胞和血生化檢測(cè)結(jié)果,采用SPSS17.0統(tǒng)計(jì)軟件包中方差分析方法對(duì)血細(xì)胞和血生化檢測(cè)結(jié)果進(jìn)行統(tǒng)計(jì)分析,用卡方檢驗(yàn)方法對(duì)病例基本信息進(jìn)行統(tǒng)計(jì)分析。 結(jié)果 1、大理地區(qū)丙型肝炎病毒基因分型 收集到疑似丙型肝炎病人血清13份,核酸檢測(cè)24、25、26、27總計(jì)4份標(biāo)本陽(yáng)性；序列分析結(jié)果顯示,4株病毒之間核苷酸同源性在80.4%-95.8%之間：24與1b型病毒核苷酸同源性最高在98.6%以上,而其他基因型病毒核苷酸同源性在90.2以下；25、27與3b型病毒核苷酸同源性在92.1%-98.6%之間,而與其他基因型核苷酸同源性均在87.4%以下；26與3a型病毒核苷酸同源性較高在94.4%-94.9%之間,而與其他基因型病毒核昔酸同源性在84.6%以下。遺傳進(jìn)化分析結(jié)果顯示25、27兩型為3b丙型肝炎病毒感染者；26病例為3a丙型肝炎病毒感染者；24為lb丙型肝炎病毒感染者。 2、單純性HCV感染與HCV合并HIV感染病人血常規(guī)和生化指標(biāo)比較分析結(jié)果 在大理州人民醫(yī)院共收集了107例病例信息,其中單純性HCV感染病例32例、合并HIV感染病例45例、排除HCV和HIV病例30例。三組中性別比例(男：女)分別為4.33:1、8：1和6.5：1,經(jīng)卡方檢驗(yàn)X2=0.922,P=0.6310.05,表明各組之間不存在明顯的性別差異；采用方差分析的統(tǒng)計(jì)方法經(jīng)SPSS17.0統(tǒng)計(jì)軟件包對(duì)三組病例的血細(xì)胞和生化檢測(cè)結(jié)果進(jìn)行統(tǒng)計(jì)分析,結(jié)果顯示單純性HCV感染病例、合并HIV感染病例和排除HCV和HIV感染病例三組病例組的WBC、RBC、 HGB、 PLT和HCT均有統(tǒng)計(jì)學(xué)差異(WBC:F=18.75,p=00.01; RBC:F=39.23, p=00.01; HGB:F=25.183, p=00.01; PLT:F=19.64, p=00.01; HCT:F=27.96, p=00.01),進(jìn)一步兩兩比較來看,HCV合并HIV感染病例組WBC、 RBC、 HGB、 PLT和HCT均低于單純性HCV感染組和對(duì)照組(P0.05)；單純性HCV感染組除了WBC與對(duì)照組無統(tǒng)計(jì)學(xué)差異外,其它4個(gè)血細(xì)胞檢測(cè)指標(biāo)RBC、 HGB、 PLT和HCT均有不同程度降低(P0.05)；在TBIL、 TP、 ALB、 ALT、 AST、AKP、GGT和TBA等8項(xiàng)肝功能檢測(cè)指標(biāo)中,ALB、 ALT、 AST、 AKP、 GGT和TBA等6項(xiàng)指標(biāo)在單純性HCV感染病例、合并HIV感染病例和排除HCV和HIV感染病例三組間均有統(tǒng)計(jì)學(xué)差異(ALB:F=3.54, p=0.0340.05; ALT:F=5.71, p=0.0050.01; AST:F=7.29, p=0.0010.01; AKP:F=10.76,p=0.0000.01; GGT:F=8.154, p=0.001＜0.01; TBA:F=8.532, p=0.0000.01),而TBIL、 TP兩項(xiàng)指標(biāo)在三組間無統(tǒng)計(jì)學(xué)意義(TBIL:F=0.356, p=0.7010.05); TP:F=0.13, p=0.8780.05)。進(jìn)一步兩兩比較來看,單純性HCV感染組的ALT、 AST、 AKP、 GGT和TBA等5項(xiàng)肝功能指標(biāo)較對(duì)照組均有不同程度升高(P0.05),而合并HIV感染病例組有ALB、 AKP、 GGT和TBA等4項(xiàng)肝功能指標(biāo)較對(duì)照組升高(P0.05),ALT和AST在單純性HCV感染組較HCV合并HIV感染病例組升高(P0.05)；HCV合并HIV感染病例組和單純性HCV感染組TBA較對(duì)照組均升高(P0.05),但以HCV合并HIV感染病例組升高更為明顯(P0.05)；在BUN、 CREA、 K+、Na+、Cl和Ca++等6項(xiàng)腎功能和電解質(zhì)檢測(cè)指標(biāo)分析中,僅有K和Ca等2項(xiàng)指標(biāo)在單純性HCV感染病例、合并HIV感染病例和排除HCV和HIV感染病例三組間均有統(tǒng)計(jì)學(xué)差異(K:F=5.56, p=0.0060.01; Ca:F=11.786, p=0.0000.01),而其余的BUN. CREA, Na和C1等4項(xiàng)指標(biāo)在三組間無統(tǒng)計(jì)學(xué)意義(BUN:F=0.331,p=0.7190.05; CREA: F=0.882,p=0.4190.05; Na:F=0.205, p=0.8150.05; Cl:F=1.182, p=0.3120.05)。進(jìn)一步對(duì)K和Ca進(jìn)行兩兩比較,單純性HCV感染組K較對(duì)照組和HCV合并HIV感染組均明顯下降(P0.05),HCV合并HIV感染組較對(duì)照組下降不明顯(P0.05)；單純性HCV感染組和HCV合并HIV感染組的Ca較對(duì)照組有不同程度的下降,但是單純性HCV感染組與HCV合并HIV感染組的Ca相比較無明顯下降(P0.05)。 結(jié)論 云南省大理地區(qū)HCV感染人群中存在基因1和基因3兩個(gè)基因型,即3a、3b和1b三個(gè)基因亞型HCV病毒流行。 HCV感染后會(huì)使病人RBC、HGB、 PLT、 HCT、 K+離子和Ca++離子水平明顯降低,ALT、 AST、AKP、 GGT和TBA水平明顯升高：而合并HIV感染后不僅加重了RBC、HGB、PLT和HCT這四項(xiàng)指標(biāo)嚴(yán)重下降,而且也使WBC水平明顯降低,TBA水平卻升高更為明顯,提示了HCV合并HIV感染加重HCV的病程和疾病的嚴(yán)重程度。
[Abstract]:objective
First of all, the hepatitis C virus (HCV) genotyping of hepatitis C virus (HCV) was studied in 13 cases of HIV combined with hepatitis C in Dali People's Hospital in 2008, providing a scientific basis for the diagnosis, treatment, prognosis, and tracing the source and route of transmission of hepatitis C virus, followed by the simple HCV infection in Dali and the blood of HCV with HIV infected patients. Cell and biochemical indicators were analyzed to provide evidence for diagnosis and treatment of simple HCV infection and HIV infection.
Method
Type specific primers were used for nested RT-PCR amplification, direct sequencing of PCR products and sequence analysis by bioinformatics software. The clinical diagnosis of simple HCV infection cases in outpatient and hospitalization in Dali People's Hospital during the month of -9 in January 2013, HCV with HIV infection cases and the basic elimination of HCV and HIV infection cases were collected. Information, blood cells and blood biochemical test results were analyzed by the method of variance analysis in SPSS17.0 software package. The results of blood cell and blood biochemical detection were statistically analyzed, and the basic information of the cases was statistically analyzed with chi square test.
Result
1, hepatitis C virus genotyping in Dali
13 serum samples of patients with suspected hepatitis C were collected and 4 samples of 24,25,26,27 were positive. Sequence analysis showed that the nucleotide homology between 4 viruses was between 80.4%-95.8%: 24 and 1b virus nucleotide homology above 98.6%, while other genotype virus nucleotide homology was less than 90.2; 25,27 and 3b The nucleotide homology of the viral nucleotides is between 92.1%-98.6%, and the homology of the other genotype nucleotides below 87.4%; 26 with 3A virus nucleotides is higher in 94.4%-94.9% than in the other genotypes of the virus, and the homology is below 84.6%. The genetic evolution analysis results show that the 25,27 type two is 3B hepatitis C virus infection Among them, 26 were 3A hepatitis C virus infection and 24 were LB hepatitis C virus infection.
2, comparative analysis of blood routine and biochemical indexes between simple HCV infection and HCV combined with HIV infection.
In Dali People's Hospital, 107 cases of case information were collected, including 32 cases of simple HCV infection, 45 cases of HIV infection and 30 cases of exclusion of HCV and HIV. The three groups (male: female) were 4.33:1,8:1 and 6.5:1 respectively, and X2=0.922 and P=0.6310.05 were tested by chi square, indicating that there was no obvious gender difference between each group. The statistical method of variance analysis was used to analyze the blood cell and biochemical test results of three groups of cases by SPSS17.0 statistical software package. The results showed that the cases of simple HCV infection, the combination of HIV infection cases and the WBC of three groups of cases excluding HCV and HIV infection cases, RBC, HGB, PLT and HCT were statistically different (WBC:F=18.75, p=00.01; p=00.01; F=39.23, p=00.01; HGB:F=25.183, p=00.01; PLT:F=19.64, p=00.01; HCT:F=27.96, p=00.01). In the further 22 comparison, HCV combined with HIV infection case group was lower than that of the simple infection group and the control group; the other 4 blood cells, except for the control group, were not statistically different from those of the control group. The detection indexes, RBC, HGB, PLT and HCT were reduced in varying degrees (P0.05), and there were 6 indexes in 8 liver function tests, such as TBIL, TP, ALB, ALT, AST, AKP, GGT, etc. P=0.0340.05; ALT:F=5.71, p=0.0050.01; AST:F=7.29, p=0.0010.01; AKP:F=10.76, p=0.0000.01; GGT:F=8.154, p=0.001 < 0.01; TBA:F=8.532, p=0.0000.01), and TBIL, there is no statistical significance between the three groups. Further 22 comparison, simple infection infection The 5 liver function indexes, such as ALT, AST, AKP, GGT and TBA, were higher than the control group (P0.05), but there were ALB, AKP, GGT and TBA in the case group with HIV infection, which was higher than the control group (P0.05). The increase of TBA in the HCV infection group was higher than that in the control group (P0.05), but the increase in the HCV combined with HIV infection group was more obvious (P0.05). In the analysis of 6 renal function and electrolyte detection indexes, such as BUN, CREA, K+, Na+, Cl and Ca++, the only 2 indexes were the cases of simple infection and the exclusion and infection of the infection cases. There were statistical differences between the three groups (K:F=5.56, p=0.0060.01; Ca:F=11.786, p=0.0000.01), while the rest of the BUN. CREA, Na and C1 were not statistically significant between the three groups (BUN:F=0.331, p=0.7190.05; CREA: F=0.882). Compared with the control group and the HIV infection group, the pure HCV infection group decreased significantly (P0.05), and the HCV combined with HIV infection group was not significantly lower than the control group (P0.05). The Ca group and the HCV combined HIV infection group had different degrees of decline, but there was no significant difference between the simple HCV infection group and the HCV combined HIV infection group. Drop (P0.05).
conclusion
There are 1 genotypes of HCV and 3 genotypes of two genes in the Dali area of Yunnan Province, namely, 3a, 3b and 1b, and the three subtypes of HCV virus are prevalent.
After HCV infection, the levels of RBC, HGB, PLT, HCT, K+ and Ca++ ions were significantly reduced, ALT, AST, AKP, GGT and TBA levels were significantly increased. Dyed the course of the HCV and the severity of the disease.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R512.63
本文編號(hào)：2128590
[Abstract]:objective
First of all, the hepatitis C virus (HCV) genotyping of hepatitis C virus (HCV) was studied in 13 cases of HIV combined with hepatitis C in Dali People's Hospital in 2008, providing a scientific basis for the diagnosis, treatment, prognosis, and tracing the source and route of transmission of hepatitis C virus, followed by the simple HCV infection in Dali and the blood of HCV with HIV infected patients. Cell and biochemical indicators were analyzed to provide evidence for diagnosis and treatment of simple HCV infection and HIV infection.
Method
Type specific primers were used for nested RT-PCR amplification, direct sequencing of PCR products and sequence analysis by bioinformatics software. The clinical diagnosis of simple HCV infection cases in outpatient and hospitalization in Dali People's Hospital during the month of -9 in January 2013, HCV with HIV infection cases and the basic elimination of HCV and HIV infection cases were collected. Information, blood cells and blood biochemical test results were analyzed by the method of variance analysis in SPSS17.0 software package. The results of blood cell and blood biochemical detection were statistically analyzed, and the basic information of the cases was statistically analyzed with chi square test.
Result
1, hepatitis C virus genotyping in Dali
13 serum samples of patients with suspected hepatitis C were collected and 4 samples of 24,25,26,27 were positive. Sequence analysis showed that the nucleotide homology between 4 viruses was between 80.4%-95.8%: 24 and 1b virus nucleotide homology above 98.6%, while other genotype virus nucleotide homology was less than 90.2; 25,27 and 3b The nucleotide homology of the viral nucleotides is between 92.1%-98.6%, and the homology of the other genotype nucleotides below 87.4%; 26 with 3A virus nucleotides is higher in 94.4%-94.9% than in the other genotypes of the virus, and the homology is below 84.6%. The genetic evolution analysis results show that the 25,27 type two is 3B hepatitis C virus infection Among them, 26 were 3A hepatitis C virus infection and 24 were LB hepatitis C virus infection.
2, comparative analysis of blood routine and biochemical indexes between simple HCV infection and HCV combined with HIV infection.
In Dali People's Hospital, 107 cases of case information were collected, including 32 cases of simple HCV infection, 45 cases of HIV infection and 30 cases of exclusion of HCV and HIV. The three groups (male: female) were 4.33:1,8:1 and 6.5:1 respectively, and X2=0.922 and P=0.6310.05 were tested by chi square, indicating that there was no obvious gender difference between each group. The statistical method of variance analysis was used to analyze the blood cell and biochemical test results of three groups of cases by SPSS17.0 statistical software package. The results showed that the cases of simple HCV infection, the combination of HIV infection cases and the WBC of three groups of cases excluding HCV and HIV infection cases, RBC, HGB, PLT and HCT were statistically different (WBC:F=18.75, p=00.01; p=00.01; F=39.23, p=00.01; HGB:F=25.183, p=00.01; PLT:F=19.64, p=00.01; HCT:F=27.96, p=00.01). In the further 22 comparison, HCV combined with HIV infection case group was lower than that of the simple infection group and the control group; the other 4 blood cells, except for the control group, were not statistically different from those of the control group. The detection indexes, RBC, HGB, PLT and HCT were reduced in varying degrees (P0.05), and there were 6 indexes in 8 liver function tests, such as TBIL, TP, ALB, ALT, AST, AKP, GGT, etc. P=0.0340.05; ALT:F=5.71, p=0.0050.01; AST:F=7.29, p=0.0010.01; AKP:F=10.76, p=0.0000.01; GGT:F=8.154, p=0.001 < 0.01; TBA:F=8.532, p=0.0000.01), and TBIL, there is no statistical significance between the three groups. Further 22 comparison, simple infection infection The 5 liver function indexes, such as ALT, AST, AKP, GGT and TBA, were higher than the control group (P0.05), but there were ALB, AKP, GGT and TBA in the case group with HIV infection, which was higher than the control group (P0.05). The increase of TBA in the HCV infection group was higher than that in the control group (P0.05), but the increase in the HCV combined with HIV infection group was more obvious (P0.05). In the analysis of 6 renal function and electrolyte detection indexes, such as BUN, CREA, K+, Na+, Cl and Ca++, the only 2 indexes were the cases of simple infection and the exclusion and infection of the infection cases. There were statistical differences between the three groups (K:F=5.56, p=0.0060.01; Ca:F=11.786, p=0.0000.01), while the rest of the BUN. CREA, Na and C1 were not statistically significant between the three groups (BUN:F=0.331, p=0.7190.05; CREA: F=0.882). Compared with the control group and the HIV infection group, the pure HCV infection group decreased significantly (P0.05), and the HCV combined with HIV infection group was not significantly lower than the control group (P0.05). The Ca group and the HCV combined HIV infection group had different degrees of decline, but there was no significant difference between the simple HCV infection group and the HCV combined HIV infection group. Drop (P0.05).
conclusion
There are 1 genotypes of HCV and 3 genotypes of two genes in the Dali area of Yunnan Province, namely, 3a, 3b and 1b, and the three subtypes of HCV virus are prevalent.
After HCV infection, the levels of RBC, HGB, PLT, HCT, K+ and Ca++ ions were significantly reduced, ALT, AST, AKP, GGT and TBA levels were significantly increased. Dyed the course of the HCV and the severity of the disease.
【學(xué)位授予單位】：昆明醫(yī)科大學(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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