C型肝炎病毒基因分型及其臨床重要性

The Genotype of Hepatitis C Virus Has Important Clinical and Therapeutic Implications

謝佩眞(Pei-Chen Hsieh) ； 郭行道(Hsing-Tao Kuo) ； 卓文春(Wen-Chun Cho) ； 廖永樑(Yung-Liang Liao) ； 林靖南(Ching-Nan Lin)

《內科學誌》 20卷4期 (2009/08) Pp. 309-319

https://doi.org/10.6314/JIMT.2009.20(4).05

摘要

C型肝炎病毒是造成輸血性肝炎、非A、B型肝炎的主因。C型肝炎以長期緩慢性病徵爲主，常發展成慢性的重大疾病，包括：肝纖維化、肝硬化與肝癌。依據C型肝炎病毒基因的序列，將現行所有的C型肝炎病毒分成6個基因型，而主要分型序列位在C型肝炎之E1、NS5B與core基因內。目前C型肝炎治療以干擾素(interferon)與雷巴威林(ribavirin)合併12-72週給藥。然而就感染第一型與第四型的C肝病毒患者而言，僅有40-50%病人可有效的消滅血中病毒，相對於感染第二型、第三型C肝病毒個體而言，有高達80%可達成此狀態。文獻指出：藥物的療效與C型肝炎基因型和突變處有關。因此，在治療C型肝炎前，辨別C型肝炎病毒之基因分型與突變分析對於臨床評估與治療方式就相當重要。本文將針對HCV基因的組成、各型別目前的治療方式，以及臨床上常用的HCV基因分型檢測法做些概略的陳述。

關鍵字

HCV基因分型 ； 肝炎 ； 干擾素 ； 雷巴威林

並列摘要

Hepatitis C virus (HCV) is a major causative agent of transfusion-associated and community-acquired non-A, non-B hepatitis that often develops into malignant chronic diseases, including liver cirrhosis and hepatocellular carcinoma. All currently known isolates of HCV can be divided into six phylogenetically distinct groups by mainly using the proportion of identical nucleotides regions within the core, E1, and NS5B. Currently, hepatitis C standard therapy consists of the combination of pegylated interferon and ribavirin, administered for 12-72 weeks. However, only 40-50% of patients infected with HCV genotypes 1 or 4 obtain a sustained virological response, compared with 80% of individuals infected with genotypes 2 or 3 who obtain a sustained virological response. Many reports show the therapeutic efficacy of hepatitis C depends on the HCV genotype, and mutations in several subgenomic regions of hepatitis C virus. Thus, it is important to know the genotype and subgenomic mutations of HCV in patients before the duration of HCV therapy. In this paper, we would narrate the importance of HCV genotypes in therapeutic implications and make a statement about the structure of HCV genome, the HCV therapy and the method of HCV genotypes detection.

並列關鍵字

HCV genotype ； Hepatitis ； Interferon ； Ribavirin