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目的:母亲乙肝病毒(HBV)感染在宫内即可造成其胎儿感染,但其机理尚不清楚.作者试图了解胎盘细胞中HBV的感染情况、宫内传播的危险因素和母胎传播的可能途径.方法:用ELISA,PCR和ABC免疫组织化学染色法检测血清和胎盘中的HBV感染标志.用病例对照方法分析危险因素.结累:101例HBsAg阳性母亲的婴儿宫内感染率为7.9%(8/101).母亲HBeAg阳性的婴儿宫内感染率明显高于母亲HBeAg阴性者(X~2=7.22,P<0.01).101例HBsAg阳性孕妇的胎盘中共检测出40例HBsAg和(或)HBeAg阳性者.其中蜕膜细胞(DC),滋养层细胞(TC),绒毛间质细胞(VSC)和绒毛毛细血管内皮细胞(VCEC)的阳性率分别为36.6%(37/101),28.7%(29/101),24.8%(25/101)和11.9%(12/101).阳性率由胎盘的母面至胎儿面有逐渐下降的趋势.由胎盘屏障的TC,VSC和VCEC感染而致的宫内传播的相对危险度比值比(OR)分别为9.13,11.68和43.50,OR值从胎盘的母面至胎儿面有逐渐上升的趋势.结论:HBV可感染胎盘组织.宫内感染的危险因素为母亲HBeAg阳性和胎盘屏障的感染.HBV经胎盘感染胎儿的途径可能是通过细胞转移方式实现的.
OBJECTIVES: The mother’s hepatitis B virus (HBV) infection can cause fetal infection in the uterus, but the mechanism is unclear.The author attempts to understand the HBV infection in placental cells, the risk factors of intrauterine transmission and the possible ways of transmitting the mother’s fetus. Methods: The markers of HBV infection in serum and placenta were detected by ELISA, PCR and ABC immunohistochemical staining, and the risk factors were analyzed by case control method. Results: The intrauterine infection rate of 101 HBsAg positive mothers was 7.9% (8 / 101), and the rate of intrauterine infection of mothers with HBeAg positive was significantly higher than that of mothers with HBeAg (X ~ 2 = 7.22, P <0.01) .Of the 101 HBsAg positive pregnant women, 40 cases of HBsAg and / or HBeAg The positive rates of decidual cells (DC), trophoblast cells (TC), villus mesenchymal cells (VSC) and villus capillary endothelial cells (VCEC) were 36.6% (37/101) and 28.7% 29/101), 24.8% (25/101), and 11.9% (12/101) .The positive rate decreased gradually from the placenta to the fetus.The positive rates of TC, VSC and VCEC from the placental barrier The odds ratios (OR) of intrauterine transmission were 9.13, 11.68 and 43.50, respectively. OR values increased gradually from the placenta to the fetus .Conclusion: HBV can infect placental tissue.The risk factors of intrauterine infection are HBeAg positive and placental barrier infection in pregnant women.HBV infection through the placenta may be achieved by means of cell transfer.