553例产妇血清、乳汁、唾液中乙型肝炎病毒-DNA载量的检测及相关性研究

摘要

目的:探讨乙型肝炎病毒(HBV)携带产妇血清中HBV标志物感染模式(HBV-M)、HBV-DNA载量与乳汁、唾液中HBV-DNA阳性率的关系,为安全进行母乳喂养和母婴亲密接触提供循证医学依据.方法:选取467例HBV携带产妇(实验组,又分为大三阳组、小三阳组和单纯阳性组)和同期86例乙型肝炎五项指标全阴的产妞(对照组),用EUSA和实时荧光定量多聚酶链反应(PCR)方法,检测产妇血清HBV-M及血清、乳汁、唾液中HBV-DNA载量,分析乳汁、唾液中HBsAg阳性率、HBV-DNA阳性率与血清HBV-M的关系,以及乳汁、唾液HBV-DNA阳性率与血清HBV-DNA载量的相关性.结果:实验组中血清大三阳组,乳汁和唾液中HBsAg阳性率和HBV-DNA阳性率均明显高于小三阳组、单纯阳性组及对照组,两两比较差异均有高度统计学意义(P＜0.01)；实验组唾液HBsAg总阳性率与HBV-DNA总阳性率均高于乳汁(P＜0.01)；乳汁和唾液HBV-DNA阳性率与血清HBV-DNA载量呈正相关(r =0.976,P＜0.01；r=0.999,P＜0.01).结论:血清大三阳产妇传染性较强；HBV携带产妇的唾液较乳汁更具有传染性；随着血清HBV-DNA载量的增加,乳汁、唾液中HBV-DNA阳性率增加,传染性增强.%Objective: To probe the relationship of hepatitis B vims serum markers (HBV-M) mode, HBV-DNA load and positive rate of HBV-DNA in milk and saliva in HBV-infected pregnant women to provide medical evidence for safe breast-feeding and close contact between mothers and infants. Methods: 467 HBV-infected pregnant women (experimental group, including HBsAg/HBeAg/HBcAb positive, HBsAg/ HBeAb/HBcAb positive, HBsAg positive) and 86 normal pregnant women (control group with all markers negative) were selected in this study. HBV-M and loads of HBV-DNA in serum, milk, and saliva were detected by enzyme linked immunosorbent assay (ELISA) and fluorescent quantitative polymerase chain reaction (PCR). The relationships among positive rates of HBsAg, HBV-DNA in milk and saliva, and serum HBV-M were analyzed, as well as and the relationship between the load of HBV-DNA and positive rates of HBV-DNA in milk and saliva were also analyzed. Results:The positive rate of HBsAg and HBV-DNA in the milk and saliva of double positive group (HBsAg/HBeAg/HBcAb) were higher than other groups includes single positive group (HBsAg/HBeAb/HBcAb), HBsAg/HBcAb group and all negative control group, and there were significant difference among the other two groups(P<0.01). In experimental group, the positive rates of HBsAg and HBV-DNA in saliva were higher than milk( P <0.01). There was positive relationship between the positive rate of HBV-DNA and the load of HBV in serum and milk and saliva( r=0. 976, P<0.01 ,r=0. 999, P<0. 01).Conclusions:The infectivity in double positive group (HBsAg/HBeAg/HBcAb) is higher. There is much more transmission of HBV in saliva than milk in HBV-infected pregnant women. With the increase of serum HBV-DNA load, the positive rate of HBV-DNA in their milk, and saliva and infectivity are also increased.