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[目的]探讨乙型肝炎病毒(HBV)通过宫内跨胎盘传播情况及其影响因素,为预防HBV母婴传播提供依据。[方法]选择上海市宝山区154名HBs Ag阳性产妇和297名HBs Ag阴性产妇分别开展流行病学问卷调查,并采集母亲外周血和新生儿脐带血来检测乙肝血清学指标及HBV DNA滴度。新生儿脐带血HBs Ag阳性与HBV DNA阳性者定义为HBV跨胎盘传播。[结果]HBs Ag阳性产妇所生新生儿脐带血HBV阳性率为8.4%。HBs Ag和HBe Ag双阳性产妇的新生儿HBV阳性率高于HBs Ag单阳性产妇的新生儿HBV阳性率(20.0%比3.7%,P<0.05),相对危险度(RR)为5.41。随着母亲外周血HBV DNA水平的提高,跨胎盘传播的发生率也逐步提高。[结论]HBe Ag可经过胎盘屏障直接传递至脐带血,而HBs Ag则受到一定程度的“过滤”。母亲HBe Ag阳性与HBV DNA高水平是HBV跨胎盘传播的主要危险因素,并可能导致新生儿免疫失败。
[Objective] To investigate the situation of hepatitis B virus (HBV) transmission through intrauterine cross-placenta and its influencing factors, and provide basis for preventing the transmission of HBV from mother to infant. [Methods] A total of 154 HBsAg-positive mothers and 297 HBsAg-negative mothers in Baoshan District of Shanghai were selected to carry out epidemiological survey and blood samples of mother’s and neonates were collected to detect hepatitis B serology and HBV DNA titer . Neonatal umbilical cord blood HBs Ag positive and HBV DNA positive were defined as HBV transplacental transmission. [Results] The positive rate of cord blood in neonates born to HBs Ag positive mothers was 8.4%. The positive rate of HBV in neonates with HBsAg and HBeAg double positive mothers was higher than that of HBsAg single positive mothers (20.0% vs 3.7%, P <0.05). The relative risk (RR) was 5.41. With the mother’s HBV DNA levels in peripheral blood increased, the incidence of transplacental transmission also gradually increased. [Conclusion] HBe Ag can be transmitted directly to umbilical cord blood through the placental barrier, while HBsAg is subject to a certain degree of “filtering”. Maternal HBeAg-positive and high HBV DNA levels are the major risk factors for HBV trans-placental transmission and may lead to neonatal immunodeficiency.