대전 지역에서 급성 A형 간염의 유전자형에 따른 임상 특성 고찰
Clinical Differences According to Genotype in Acute Viral Hepatitis A in Daejeon, Korea
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목적: B형 간염이나 C형 간염 등은 유전자형에 따른 차이가 알려져 있지만, 국내에서 증가하는 IIIA 유전자형과 기존의 IA 유전자형에 의한 간염의 차이가 거의 알려진 바 없다. 따라서 대전 지역에서 발생한 급성 A형 간염의 유전자형에 따른 차이를 알고자 한다. 방법: 2009년 11월부터 2010년 6월까지 급성 A형 간염으로 진단되면서 유전자형이 확인된 81명의 환자를 대상으로 임상적 소견들과 검사실 소견들을 전향적으로 연구하였다. 결과: 평균 나이는 32.6 ± 7.4세이며, 평균 입원 기간은 7.7 ± 2.4일이었다. 직업은 서비스직, 사무직 그리고 교육직이 가장 많았다. 유전자형 간의 급성 간염에 따른 증상들의 종류는 별다른 차이가 없었다. 유전자형에 따른 증상의 빈도는 IIIA 유전자형에서 구토와 설사가, IA 유전자형에서는 복통과 피부 반점이 상대적으로 많았다. 검사실 소견에서는 IIIA 유전자형에서 헤모글로빈의 평균, CRP 평균, AST 최대 수치 평균은 상대적으로 유의하게 높았다. 그리고 AST와 ALT 및 총 빌리루빈 최대 수치들과 INR의 수치가 IIIA 유전자형에서 상대적으로 높게 분포하는 경향을 보였다. 결론: 대전 지역에서 유행하는 급성 A형 간염에서 IIIA 유전자형에 따른 급성 간염은 기존의 IA 유전자형과 차이가 있을 것으로 보이며, 다기관 연구를 통한 심도 깊은 연구가 필요하겠다.
Abstract
Background/Aims:Acute viral hepatitis A is a major health problem in Korea and the influx of genotype IIIA is thought to be one reason. We examined the differences in the clinical characteristics and laboratory findings of genotypes IA and IIIA in Daejeon. Methods:From November 2009 to June 2010, 81 patients positive for IgM anti-HAV were enrolled prospectively. The hepatitis A was genotyped using real-time polymerase chain reaction. The clinical characteristics and laboratory results were compared on the basis of genotype. Results:The mean patient age was 32.6 ± 7.4 years. The mean hospitalization was 7.7 ± 2.4 days. The patient occupation varied. Clinically, vomiting and diarrhea were relatively more prevalent in genotype IIIA than in IA. Abdominal pain and skin spots were relatively more prevalent in genotype IA than in IIIA. The hemoglobin, peak aspartate aminotransferase (AST) level, and C-reactive protein were statistically higher in genotype IIIA than in IA. The distributions of the peak AST, alanine aminotransferase (ALT) and total bilirubin values tended to be perched in genotype IIIA than in IA. The international normalized ratio (INR) tended to be slightly prolonged in genotype IIIA than in IA. Conclusions: Recently, genotype IIIA of acute viral hepatitis A has become prevalent in Daejeon. Hepatitis A genotype IIIA probably causes worse laboratory abnormalities than genotype IA. (Korean J Med 2011;80:553-561)
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