乙肝病毒携带孕妇羊膜腔穿刺术后胎儿宫内感染的风险

摘要

目的：探讨乙肝病毒（hepatitis B virus, HBV）携带孕妇羊膜腔穿刺术后胎儿宫内感染的风险是否增加，以便对HBV携带孕妇提供科学的产前诊断指导。方法用酶联免疫吸附法及实时荧光定量PCR法检测178例HBV携带孕妇血清、新生儿脐血、出生后6月龄婴儿外周血HBV血清学标志物及HBV-DNA载量。41例行羊膜腔穿刺术为实验组，137例未行羊膜腔穿刺为对照组。两组内根据孕期不同HBV携带情况及胎盘位置分为：乙肝病毒表面抗原（Hepatitis B virus surface antigen，HBsAg）阳性、乙肝病毒e抗原（viral hepatitis B virus e antigen，HBeAg）阴性组；HBsAg阳性、HBeAg阳性组；HBV-DNA<1.0×103 cps/ml组；1.0×103-1.0×107 cps/ml组；≥1.0×107 cps/ml组；胎盘前壁组；胎盘后壁组。将实验组与对照组在不同HBV携带情况及不同胎盘位置时的宫内感染率分别进行比较及统计学分析。结果当HBV-DNA≥1.0×107 cps/ml时，胎儿宫内感染率实验组（50%）高于对照组（6.38%），且差别具有统计学意义（χ2=7.931, P=0.043）。其它不同HBV携带情况及不同胎盘位置时两组间胎儿宫内感染率差别均无统计学意义(χ2=1.165, P>0.05)。结论当孕妇HBV-DNA≥1.0×107 cps/ml时，羊膜腔穿刺术可能增加胎儿宫内感染的风险。其它HBV携带情况及不同胎盘位置，羊膜腔穿刺术并不增加胎儿宫内感染的风险。故对有产前诊断指征的HBV携带孕妇，需在产前诊断前对其进行HBV-DNA检测及分级，根据检测结果进行科学的产前诊断指导。%Objective To investigate the risk of intrauterine fetal infection in pregnant women infected with HBV=after amniocentesis and provide scientific guidance for prenatal diagnosis. Methods HBV serological markers and HBV-DNA load of HBV carrier maternal blood, neonatal cord blood and peripheral blood of 6-month-old infants in 178 cases were detected by using ELISA and real-time PCR method. All the cases were divided into two groups, the experimental group (n=41) which pregnant women infected with HBV accepted amniocentesis, and the control group(n=137)which the pregnant women infected with HBV did not receive amniocentesis. According to the different HBV carrying case and placental location both groups are divided into:the hepatitis B virus surface antigen (HBsAg)-positive, hepatitis B virus e antigen (HBeAg)-negative group; HBsAg positive, HBeAg-positive group; HBV-DNA <1.0 × 103 cps/ml group; 1.0 × 103-1.0 × 107 cps/ml group; HBV-DNA≥ 1.0 × 107 cps/ml group; placenta anterior group; placenta posterior group. The intrauterine fetal infection rate of different HBV carry situations and different placental locations of both groups were compared statistical analyzed. Results When HBV-DNA≥1.0 × 107 cps/ml, the intrauterine fetal infection rate in the experimental group (50%) was higher than the control group (6.38%), and the difference was statistically significant (χ2=7.931, P=0.043). In other cases of different HBV carrying situations and different locations of the placenta, the intrauterine fetal infection rate between the two groups was not statistically significant difference (χ2=1.165, P=0.210). Conclusions Therefore, When the pregnant women's blood HBV-DNA≥1.0×107 cps/ml, the amniocentesis may increase the risk of intrauterine fetal infection rate, to other cases,the amniocentesis won't increase the risk of intrauterine fetal infection rate, therefore, it needs to detect and classify the HBV-DNA of pregnant women infected with HBV before prenatal diagnosis, and the scientific guidance of prenatal diagnosis must based on these results.