围产期母血与脐血乙肝标志物及DNA载量关联性研究

摘要

目的 研究围产期母血与新生儿脐血乙肝病毒标志物及核酸DNA载量的关联性,探索脐血乙肝五项模式与HBV-DNA载量之间关系,用于评估新生儿宫内感染乙肝病毒的风险性.方法 在知情同意的原则下选择住院分娩产妇612例作为乙肝研究对象,根据产妇乙肝五项不同模式共分为五组,均采用ELISA法检测产妇血清、新生儿脐血HBV标志物,同时用实时荧光定量PCR检测产妇血清和脐血新鲜血清HBV-DNA载量,探讨围产期母血与脐血间HBV-DNA载量的关联性.结果 年龄在18 ～ 44岁围产期妇女,A组传染性强的乙肝“大三阳”或1,3阳性者149例,产妇血清和脐血HBV-DNA阳性率分别为99.33％和32.21％;B组260例乙肝“小三阳”,产妇血清和脐血HBV-DNA阳性率分别为20.00％和3.08％;C组乙肝1、5阳性者58例,产妇血清和脐血HBV-DNA阳性率分别为65.52％和12.07％;D组乙肝病毒第5阳性者59例,产妇血清和脐血HBV-DNA阳性率分别为13.56％和1.69％;E组对照组:乙肝五项全阴性86例,产妇血清和脐血HBV-DNA阳性率分别为1.16％和0.A组与B组间脐血HBV-DNA阳性率,差别有统计学意义(x2=54.09,P＜0.01).乙肝产妇所生新生儿脐血HBeAg阳性率高达82.55％,脐血HBsAg的阳性率为32.89％,A组即HBsAg HBeAg阳性的产妇经胎盘传播乙肝病毒的概率(32.21％)明显高于B组“小三阳”产妇的脐血HBV-DNA感染率(3.02％),A组是B组的10.67倍;传染性强的A组母血是脐血HBV-DNA平均载量的6345倍.结论 ①新生儿宫内感染乙肝病毒阳性率与围产期母体内HBV-DNA载量呈正相关.②乙肝产妇生产的新生儿脐血HBeAg阳性率是HBsAg的2.51倍,要研制复合型乙型肝炎人免疫球蛋白:即增加高效价HBeAb成分可结合HBeAg,原有的HBsAb也可结合相应的HBsAg,增强阻断乙肝病毒垂直传播作用;③我国应加强乙肝知识的宣教工作,完善围产保健制度.%Objective To investigate the correlations of hepatitis B virus markers and hepatitis B virus-DNA vectors in blood between women in perinatal period and cord blood,and to assess the risk of HBV infections status in pregnant women to intrauterine fetal infective.Methods We selected 612 pregnant women who decided to delivery in hospital,in compliance with the principles of informed consent.According the difference of hepatitis virus serological markers existing in pregnant women,samples were divided into six groups.We used enzyme-linked immunosorbent assay to detect hepatitis virus serological markers,existing in serum of mother and cord blood.Real-time fluorescence quantitative PCR was supplied to test HBV-DNA load levels in these two kinds of biological specimen.Results In group A,hepatitis B virus " big 3 positives " or 1,3 positive 149 lying-in woman examples,two positive rates of HBV-DNA about pregnant women and cord blood are 99.33％ and 32.21％ ; in group B,positive rates of HBV-DNA in two kinds of specimen are 20.00％ and 3.08％ ; in group C and D,two positive rates are and the average contents of HBV-DNA,the results as mentioned in each group respectively are 65.52％,12.07％ and 13.56％,1.69％ respectively.Control group is group E,86 lying-in woman examples and the detecting results orderly are 1.16％,0.There was a significant difference in positive rate of HBV-DNA in cord blood between group A and group B subgroups (x2 =54.09,P ＜ 0.01).There is significant positive correlation between HBV-DNA vectors existing in mother's serum and the positive rate of HBV-DNA in cord blood.Hepatitis B virus the mother blood " big 3 positives " is the umbilicus blood HBV-DNA 6345 times that carries quantity in average.Conclusion ① During the perinatal period,along with the HBV-DNA load levels arising of pregnant women,the risk of HBV infections status in pregnant women to intrauterine fetal infective increased.②Suggeste to develop the compound pattern human hepatitis B immunoglobulin:Increase the composition of efficient price HBeAb-can be combinated HBeAg,HBsAb can be combinated HBsAg,strengthen the hinderance and break hepatitis B virus disseminate.③Our government should strengthen the propaganda of hepatitis B virus education.Establish and perfect to surround and produce the system of health protection.