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目的研究产妇血清与其初乳汁乙型肝炎病毒(HBV)DNA载量的关联性。方法选取住院分娩产妇共522例,依据HBV五项血清学指标,分为A组:乙肝“HBsAg、HBeAg、HBcAb均阳性”103例,B组:乙肝“HBsAg、HBeAb、HB-cAb均阳性”221例,C组:HBsAg、HBeAg阳性20例,D组:HBsAg、HBcAb阳性43例,E组:乙肝其他血清模式49例,另选F组:HBV模式全阴性的产妇86例作为对照组;均采用ELISA法检测产妇血清、乳汁中HBV标志物HBsAg、HBsAb、HBeAg、HBeAb、HBcAb,阳性者采用该项目胶体金标试纸复核,同时采用实时荧光定量PCR检测产妇血清和乳汁HBVDNA载量,对相关数据进行统计分析。结果对年龄18～44岁围产期妇女体检乙肝感染指标,A组乙肝“HBsAg、HBeAg、HBcAb均阳性”产妇血清和乳汁HBV DNA诊断灵敏度分别为100.00%(103/103)和86.41%(89/103)、血清HBV DNA载量平均为4.11×108copies/ml;B组乙肝“HBsAg、HBeAb、HBcAb均阳性”产妇血清和乳汁HBV DNA诊断灵敏度分别为19.46%(43/221)和2.71%(6/221),血清HBV DNA载量平均为6.85×104copies/ml;C组乙肝HBsAg、HBeAg阳性产妇血清和乳汁HBV DNA诊断灵敏度分别为100.00%(20/20)和80.00%(16/20),血清HBV DNA载量平均为8.27×106copies/ml;D组HBsAg、HBcAb阳性产妇血清和乳汁HBV DNA诊断灵敏度分别为65.12%(28/43)和25.58%(11/43),血清HBV DNA载量平均为2.89×105copies/ml;E组HBV其他模式产妇血清和乳汁HBV DNA诊断灵敏度分别为10.20%(5/49)和2.04%(1/49),血清HBV DNA载量平均为1.59×104copies/ml;F组乙肝五项全阴性产妇血清和乳汁HBV DNA诊断灵敏度分别为1.16%(1/86)和0(0/86),血清HBV DNA载量<1.00×103copies/ml。A组与B组间乳汁HBV DNA实验诊断阳性差异有统计学意义(χ2=237.45,P<0.01)。HBV携带者乳汁HBV DNA载量与其血液HBVDNA载量呈正相关(r=0.721)。结论携带HBV产妇乳汁HBV DNA载量远低于血液HBV DNA载量;乳汁中HBV传染性也低于血液传染性;研究证实A组产妇经母乳HBV传染性是“HBsAg、HBeAb、HBcAb均阳性”产妇的87.45倍,HBV其他模式者乳汁传染性与乙肝“HBsAg、HBeAb、HBcAb均阳性”产妇乳汁传染性相近。
Objective To study the relationship between maternal serum and the DNA load of hepatitis B virus (HBV) in colostrum. Methods A total of 522 inpatient delivery women were enrolled in this study. According to the five serological markers of HBV, group A was divided into group A: group B with 103 cases with positive HBsAg, HBeAg and HBcAb; group B with HBsAg, HBeAb and HB-cAb In group C, HBsAg and HBeAg were positive in 20 cases and in group D: HBsAg and HBcAb were positive in group D, while in group E, 49 cases were seropositive for hepatitis B and 86 cases were all negative for HBV. As the control group; all the HBV markers HBsAg, HBsAb, HBeAg, HBeAb and HBcAb in maternal serum and breast milk were detected by ELISA, and the colloidal gold standard test paper was used for the review. Meanwhile, the serum and milk HBVDNA Load, the relevant data for statistical analysis. Results The diagnostic sensitivity of serum HBV DNA to maternal serum HBV DNA in group A was 100.00% (103/103) and 86.41% (89/103). The average serum HBV DNA load was 4.11 × 108 copies / ml. The diagnostic sensitivity of serological and milk HBV DNA in group B was 19.46% (43/221) And 2.71% (6/221) respectively. The average serum HBV DNA load was 6.85 × 104copies / ml. The diagnostic sensitivity of serological and milk HBV DNA of HBsAg and HBeAg positive males in group C were 100.00% (20/20) and 80.00% The average serum HBV DNA load was 8.27 × 106 copies / ml. The diagnostic sensitivity of HBV DNA in serum and milk of HBsAg and HBcAb positive patients in group D were 65.12% (28/43) and 25.58% (11/43), respectively, The average serum HBV DNA load was 2.89 × 105 copies / ml. The diagnostic sensitivity of HBV DNA in serum and milk of the other groups in E group were 10.20% (5/49) and 2.04% (1/49), respectively. The serum HBV DNA load average (1.59 × 104copies / ml). The diagnostic sensitivity of HBV DNA in the serum and milk of the patients with F-serogroup B hepatitis B were 1.16% (1/86) and 0 (0/86) respectively, and the serum HBV DNA load was less than 1.00 × 10 3copies / ml. There was a statistically significant difference in the diagnostic value of milk HBV DNA between group A and group B (χ2 = 237.45, P <0.01). The serum HBV DNA load of HBV carriers was positively correlated with the blood HBV DNA load (r = 0.721). Conclusion The HBV DNA load in breast milk of HBV carriers is much lower than that of blood HBV DNA. The HBV infectivity in breast milk is also lower than that of blood transfusion. The study confirmed that the HBV infectivity of breast milk in group A was “HBsAg positive, HBeAb and HBcAb positive ”87.45 times the mothers, HBV other modes of breast contagious and hepatitis B “ HBsAg, HBeAb, HBcAb are positive ”maternal milk contagious similar.