Investigation of Hepatitis B in Residents of Rural Areas and Aborigines in Taiwan

• Main Authors: Hsiao-Ching Nien, 粘曉菁
• Other Authors: Jin-Chuan Sheu
• Format: Others
• Language: zh-TW
• Online Access: http://ndltd.ncl.edu.tw/handle/04376775553955960774

碩士 === 臺灣大學 === 臨床醫學研究所 === 98 === Background: Hepatitis B virus (HBV) infection is the major cause of hepatocellular carcinoma (HCC) in Taiwan. The standardized mortality rates of chronic liver diseases and liver cirrhosis are higher in Taiwanese aborigines than non-aborigines. However, the standardized mortality rate of HCC is slightly lower in Taiwanese aborigines. High HBV DNA, positive HBeAg and genotype C have been shown be the risks for the HBV-related HCC. Therefore, in this study we further investigated the distributions of HCC related risk factors in HBV patients and HBV genotype among different regional areas and ethnic groups. Materials and methods: A total of 3,488 patients (1,527 aborigines and 1,961 non-aborigines) with HBV infection were recruited from various regions in Taiwan. Basic background information and blood samples were collected and abdominal ultrasound examinations were done. The blood samples were checked for AST, ALT, AFP, HBeAg, anti-HBe, HBV DNA by Real-Time PCR (polymerase chain reaction, PCR) and genotype by nested PCR (nested polymerase chain reaction) and multiplex-PCR (multiplex-polymerase chain reaction). The accuracy of HBV genotypes was validated with full length sequence. Results: There were no differences in the mean age (50 years old) and mean ALT levels (39 U/L) between aborigines and non-aborigines. However, lower HBeAg-positive rate (5.3% vs. 10.2%, p<0.0001), lower rate of HBV DNA > 2,000 IU/ml (27.4% vs. 36.7%, p<0.0001), higher rate of drinking habit（40.0% vs. 19.3%, p<0.0001）were noted in aborigines than non-aborigines. Among 1,178 patients with complete data of genotype and HBeAg, the prevalence of genotype B in aborigine group was higher (92.7%) than that in non-aborigine group (72.7%) in any age group (p<0.05), especially in Tsou (97%). The dominant genotype was C in non-aborigines in Penghu County and Lienchiang County (60%) and was genotype B in the countries of Taiwan island (89%). Besides, our research found 13 patients with genotype D, a very rare genotype in Taiwan. Patients with genotype D were clustered in the local Paiwan tribe of Pingtung County. These subjects had higher HBV DNA (greater than 2,000 IU/ml) without the experience of sharing needles with others and some of them had received blood transfusion or surgeries or tattoo or piercings. Conclusion: We found Taiwanese aborigines who belong to Austronesian language populations have lower HBV DNA viral load, lower HBeAg-positive rate and higher prevalence of HBV genotype B when compared with non-aborigines. Therefore, HBV infection is not the major cause of the death of chronic liver diseases in Taiwanese aborigines. A cluster of patients with HBV genotype D was found in the local area of southern Taiwan.