不同HBV感染模式产妇乳汁中HBV-DNA载量及肝功能分析

摘要

目的 研究乙型肝炎阳性产妇感染模式,以及血清中乙型肝炎病毒(HBV)-DNA载量与乳汁中HBV-DNA载量的关系,乳汁中HBV-DNA载量与产妇肝功能的关系,评价母乳喂养的安全性.方法 对267例HBV携带产妇,用酶联免疫吸附试验(ELISA)法检测乙型肝炎表面抗原(HBsAg)和乙型肝炎e抗原(HBeAg),用荧光定量PCR技术检测血清中和乳汁中HBV-DNA载量,采用速率法检测丙氨酸氨基转移酶(ALT).结果 109例HBsAg和HBeAg双阳性的产妇,其乳汁HBV-DNA阳性率为76.1%,158例HBsAg阳性而HBeAg阴性产妇乳汁HBV-DNA阳性率为3.2%,差异有统计学意义(P<0.05).观察产妇其血清中携带不同载量的HBV-DNA,分别为HBV-DNA<500、500~1.0×105、>1.0×105 copies/mL 3组,其两两比较乳汁中HBV-DNA载量差异有统计学意义(P<0.05),且血清中HBV-DNA载量与乳汁中HBV-DNA载量呈正相关关系;乳汁中HBV-DNA阳性与乳汁中HBV-DNA阴性产妇血清ALT进行比较,差异有统计学意义(P<0.05).结论 HBsAg和HBeAg双阳性和血清中HBV-DNA>1.0×105 copies/mL的产妇不宜母乳喂养,同时乳汁中HBV-DNA载量较高的产妇应同时密切监测肝功能,以防发生肝损伤.%Objective To study the relationship between the infection patterns of hepatitis B positive maternal and the hepatitis B virus (HBV)-DNA load in serum and the HBV-DNA load in breast milk ,the relationship between HBV-DNA load in the breast milk and maternal liver function ,and evaluate the safety of breast feeding .Methods HBsAg and HBeAg were detected by ELISA in 267 cases of hepatitis B positive maternal ,HBV-DNA load in serum and breast milk was detected by fluorescent quantitative PCR ,and alanine aminotransferase (ALT ) was detected by rate method .Results The positive rate of breast milk HBV-DNA in 109 cases of HBsAg and HBeAg double positive was 76 .1% ,the positive rate of breast milk HBV-DNA in 158 cases of HBsAg positive and HBeAg negative women was 3 .2% ,the difference was statistically significant (P<0 .05) .3 groups of women were observed to carry different loads of HBV-DNA in their serum ,HBV-DNA < 500 ,500 -1 .0 × 105 ,> 1 .0 × 105 copies/mL ,respectively ;the difference of HBV-DNA load in breast milk was statistically significant (P<0 .05) ,and there was a positive correlation between HBV-DNA load in serum and HBV-DNA load in breast milk ;there were significant differences in serum ALT between HBV-DNA positive breast milk maternal and HBV-DNA negative maternal(P<0 .05) .Conclusion HBsAg and HBeAg double positive mater-nal and the maternal whose HBV-DNA load >1 .0 × 105 copies/mL in serum are not appropriated to breast-feeding .Women with high HBV-DNA load in breast milk should monitor liver function at the same time ,so as to prevent liver injury .