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目的 探讨乙型肝炎病毒（（Hepatitis B virus,HBV））-DNA载量及BCP区双变异对乙肝肝硬化患者食管胃底静脉曲张（EGV）严重程度的影响。方法 回顾性纳入2022年11月至2025年11月于我院就诊的326例乙肝肝硬化患者，根据内镜下EGV分级分为轻度组、中度组、重度组。检测患者血清HBV-DNA载量及病毒变异情况，并通过体外细胞实验验证变异株的复制能力。采用Spearman秩相关与多因素有序Logistic回归分析EGV严重程度的影响因素。结果 患者血清HBV-DNA载量、总胆红素（TBIL）、凝血酶原时间（PT）呈升高趋势，白蛋白（ALB）呈降低趋势（P<0.001）,HBV BCP区双变异（A1762T/G1764A）检出率升高（P<0.001）。体外实验显示，变异型（MT）组细胞内HBV松弛环状DNA(rcDNA)、共价闭合环状DNA(cccDNA)水平高于野生型（WT）组（P<0.05），细胞培养上清中乙型肝炎病毒表面抗原（HBsAg）、乙型肝炎病毒e抗原（HBeAg）表达水平高于WT组（P<0.05）。血清HBV-DNA载量与EGV严重程度、TBIL、PT呈正相关（r=0.501、0.230、0.240,P<0.001），与ALB水平呈负相关（r=-0.192,P<0.001）。高HBV-DNA载量、HBV BCP区双变异、高TBIL水平、PT延长是乙肝肝硬化患者发生EGV严重程度升高的独立危险因素，高ALB水平是其独立保护因素（P<0.05）。结论 血清HBV-DNA载量与乙肝肝硬化患者EGV严重程度呈正相关，高HBV-DNA载量、HBV BCP区A1762T/G1764A双变异、高TBIL水平、PT延长是乙肝肝硬化患者EGV进展的独立危险因素，高ALB水平是其独立保护因素。BCP区双变异可增强HBV的复制能力。
Abstract：Objective To investigate the association of hepatitis B virus(HBV)-DNA load and basal core promoter(BCP) region double mutation with the severity of esophagogastric varices(EGV) in patients with hepatitis B cirrhosis.Methods A total of 326 patients with hepatitis B cirrhosis who attended our hospital from November 2022 to November 2025 were retrospectively enrolled.Based on endoscopic EGV grading,patients were divided into mild,moderate,and severe groups.Serum HBV-DNA load and viral mutations were measured,and the replication capacity of mutant strains was verified by in vitro cellular experiments.Spearman's rank correlation and multivariate ordinal logistic regression were used to analyze factors influencing EGV severity.Results As EGV grade increased,serum HBV-DNA load,total bilirubin(TBIL),and prothrombin time(PT) showed increasing trends,while albumin(ALB) decreased(P<0.001);the detection rate of the HBV BCP double mutation(A1762T/G1764A) also increased(P<0.001).In vitro experiments showed that the mutant(MT) group had higher intracellular levels of HBV relaxed circular DNA(rcDNA) and covalently closed circular DNA(cccDNA) than the wild-type(WT) group(P<0.05),and the expression levels of hepatitis B surface antigen(HBsAg) and hepatitis B e antigen(HBeAg) in the culture supernatant were also higher(P<0.05).Serum HBV-DNA load was positively correlated with EGV severity,TBIL,and PT(r=0.501,0.230,and 0.240,respectively;all P<0.001),and negatively correlated with ALB(r=-0.192,P<0.001).High HBV-DNA load,HBV BCP double mutation,elevated TBIL,and prolonged PT were independent risk factors for increased EGV severity,whereas high ALB was an independent protective factor(all P<0.05).Conclusion Serum HBV-DNA load is positively correlated with EGV severity in patients with hepatitis B cirrhosis.High HBV-DNA load,HBV BCP A1762T/G1764A double mutation,high TBIL level,and prolonged PT are independent risk factors for severe EGV,whereas high ALB level is an independent protective factor.The BCP double mutation enhances HBV replication capacity.
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基本信息:
DOI：10.13242/j.cnki.bingduxuebao.260140
中图分类号:R575.2;R512.62
引用信息:
[1]陈雅菲,李小环,毛建娜.HBV-DNA载量与BCP区双变异对乙肝肝硬化EGV严重程度的影响[J].病毒学报,2026,42(04):1324-1329.DOI:10.13242/j.cnki.bingduxuebao.260140.
2026-07-10
2026-07-10
2026-07-10