乙肝病毒携带产妇血清标志物模式与血清及乳汁HBV-DNA相关性研究

摘要

目的：通过检测分析乙肝病毒携带产妇血清学标志物与血清、乳汁HBV-DNA阳性率的关系，以及产妇血清与乳汁中HBV-DNA含量之间的相关性，旨在指导母乳喂养。方法选取96例乙肝病毒携带产妇，将其分为大三阳组(54例)、小三阳组(25例)、HbsAg和HbeAg均阳性组（8例）及HbsAg和HbcAb均阳性组（9例）。另选取12例乙肝两对半全阴的产妇作为对照组。ELISA法检测乙肝病毒携带产妇乙肝免疫血清学标志物，实时荧光定量PCR法分别检测产妇血清与乳汁中HBV-DNA含量，并对所有检测指标进行相关性分析。结果大三阳组产妇血清和乳汁HBV-DNA阳性率明显高于其他三组(P<0.05)。乳汁HBV-DNA在各组中检出的阳性率均小于血清HBV-DNA，但两者差异无统计学意义(P>0.05)。根据乙型肝炎血清学标志物HBeAg是否阳性将96例产妇分为HBeAg阳性组(62例)和HBeAg阴性组(34例)，血清HBeAg阳性产妇的血清和乳汁中HBV-DNA阳性率均明显高于HBeAg阴性产妇，差异具有统计学意义(P<0.01)。但一部分血清HBeAg阴性产妇血清和乳汁中HBV-DNA亦为阳性。产妇血清与乳汁中HBV-DNA含量呈正相关(r=0.891，P<0.05)。结论乙肝病毒携带产妇乳汁HBV-DNA检出的阳性率低于血清HBV-DNA，且乳汁HBV-DNA含量随血清HBV-DNA含量的升高而增大，因此定量双重检测产妇血清、乳汁中HBV-DNA来确定母婴乙肝病毒传播的风险性更为可靠，这将有利于阻断乙肝传播，确定哺乳方式，指导母乳喂养，从而降低乙肝新生儿感染率。%Objective Through analysis of the relationship between the hepatitis B serum markers in HBV-infectious pregnant women and the HBV-DNA positive rate in serum and milk, and the correlation serum and milk HBV-DNA in HBV-infectious pregnant woman, we aimed to explore some instructions on breast-feeding. Methods Ninety-six HBV-infectious pregnant women were divided into four groups, including large three-positive group, small three-positive group, HbsAg and HbeAg positive group, and HbsAg and HbcAb positive group. Another 12 women with hepatitis B two pairs of semi-five indicators all negative were chosen as control group. The hepatitis B virus immune markers in serum were detected by ELISA while HBV-DNA level in serum and milk was determined by real time RT-PCR, and the correlation between the detecting results were analyzed. Results The positive rates of HBV-DNA in serum and milk of large three positive group were significantly higher than those in the other three groups (P<0.05). Among all groups, the positive rates of HBV-DNA in milk were less than those in serum with no sig-nificant difference (P>0.05). The HBV-DNA positive rates in serum and milk in HBeAg positive groups were obvious-ly higher than that in HBeAg-negative group (P<0.01). However, HBV-DNA in serum and milk were also detected in part of the HBeAg-negative pregnancy women. The HBV-DNA content in serum had positive relation with HBV-DNA content in milk (r=0.891, P<0.05). Conclusion In HBV- infectious pregnant women, it is found that the HBV-DNA positive rate in milk was less than that in serum, and the content of HBV-DNA in milk was increased along with that increased in serum. Therefore, it is more reliable to determine the risk of hepatitis B virus transmission from mother to infant by quantitative measurement of HBV-DNA in serum and milk. It is helpful in interrupting HBV trans-mission, deciding the mode of breast-feeding, and guiding breast-feeding, so as to decrease the infectious rate of baby.