Korean J Hepatol > Volume 6(4); 2000 > Article
The Korean Journal of Hepatology 2000;6(4): 425-440.
원저 / 만성 B형 간염 환자에서 HBV X , core promoter , precore 변이종의 임상적 중요성 ( Clinicopathologic Significance of HBV X , Core promoter , Precore Mutants in Patients with Chronic HBV Infection )
Clinicopathologic Significance of HBV X , Core promoter , Precore Mutants in Patients with Chronic HBV Infection
Yeon Jae Lee,Young Il Yang,Sung Soo Ye,Won Hee Jang,Gye Hyung Baek
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There have been much debates on the effects of HBV mutants on the clinical course of HBV-associated chronic liver diseases. The purpose of this study was to define the relationship among HBV mutants, severity of hepatitis and expression patterns of HBcAg
HBV DNA was extracted from the liver tissue of 31 patients who had been HBsAg positive for more than 6 months. The amplification of X was performed as well as core promoter/precore region of HBV DNA by polymerase chain reaction and then direct sequencing of them. Pathologic severity was classified utilizing Scheuer's scoring system and immunohistochemical staing for HBcAg in hepatocytes was performed. The expression patterns of HBcAg were divided into four types according to expression location of HBcAg: Type Ⅰas a nuclear predominant expression of HBcAg; Type II as mixed patterns, combined expression of cytoplasmic and nuclear localization of HBcAg; Type III as a diffuse cytoplasmic expression of HBcAg; and Type Ⅱ as an inclusive body-like expression in cytoplasm.
In investigating the relationship between HBV mutants and clinical findings, ALT, HBV DNA and hepatitis activity index (HAI) in hepatitis with wild HBV were normal to high but those in hepatitis with core promoter or precore mutants were high . There were no statistically significant differences (p=0.062). In terms of the relationship between HBV mutants and the expression pattern of HBcAg, type Ⅰ, Ⅱ, Ⅳ were noticed in hepatitis with wild HBV but in almost all mutants cases type Ⅲ, Ⅱ were noticed (p<0.01). The score of HAI increased as the number of the expression pattern of HBcAg increased from type Ⅰto type Ⅲ or Ⅳ(p<0.05). No relationships among the mutation in X region, the mutations in other regions and clinicopathological severity could be found.
The mutation in X, core promoter and precore region had little association with the severity of hepatitis. And the relationship did not exist between precore mutants and X mutants. The expression pattern of HBcAg could be a useful indicator in determining what stage of chronic hepatitis B is in and whether mutant strains exist.
KeyWords: Hepatitis B, X, core promoter , precore mutant s

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