乙型肝炎病毒胎盘垂直传播的机制  

Mechanism of intrauterine transmission of hepatitis B virus

作　　者：孙成福[1] 兰孟东[2] 成军[3] 李朝品[1] 郎振为[2] 李国力[3] 王琦[3] 

机构地区：[1]安徽理工大学医学院,淮南市232001 [2]北京地坛医院病理科 [3]北京地坛医院传染病研究所

出　　处：《热带病与寄生虫学》2009年第1期7-9,封2,共4页Journal of Tropical Diseases and Parasitology

摘　　要：目的研究胎盘组织中HBV感染与胎儿宫内感染的关系。方法携带HBsAg的孕妇,血清HBV DNA阴性12例;血清HBV DNA阳性19例;血清HBV DNA阳性,孕晚期拉米夫定治疗16例;血清HBV DNA阳性,孕晚期免疫球蛋白(HBIG)治疗19例。使用免疫组化与原位聚合酶链反应(In situpolymerase chain reaction,IS PCR),检测胎盘组织中的HBcAg与乙型肝炎共价环状DNA(HBV covalentlyclosed circular DNA,HBV cccDNA)。结果胎盘绒毛炎发生率与婴儿发生宫内感染率具有明显相关性(P<0.05);胎盘HBcAg的感染率与婴儿发生宫内感染率之间具有明显的相关性(P<0.05);治疗后,胎盘HBVccc DNA感染与婴儿发生宫内感染没有显著差异性(P>0.05)。结论胎盘组织发生炎症,使部分绒毛发生纤维素样坏死,胎盘屏障受损,通透性增加,HBV易通过胎盘屏障感染胎儿;HBcAg在胎盘中的表达,表明HBV感染与复制,是导致宫内感染的危险因素;阻断治疗可能抑制了感染胎盘组织cccDNA复制,使宫内感染的危险性降低。Objective To study the relationship between fetal infection and placental infection of HBV. Methods 66 pregnant women with HBsAg were chosen, of which 12 cases were plasma HBVDNA negative, 19 cases were plasma HBV DNA positive, 16 cases were plasma HBV DNA positive and received lamivudine treatment in late , and 19 cases were plasma HBV DNA positive and received immunity globulin (HBIG) treatmeat in late . The HBcAg and the cccDNA in placenta tissue of all cases were detected by immunohistochemistry and in situ polymerase chain reaction respectively. Results The villositis incidence rate and the HBcAg infection rate of the placenta tissue had respectively obvious relativity with the foetus infection rate (both P< 0.05). There was no obvious difference between HBV cccDNA infection in the placenta tissue and the foetus infection after treatment (P>0.05). Conclusions The occurrence of inflamation in the placenta tissue making part of villus occur fibrinoid necrosis. The transparence is increased with the placenta shield damaged, and HBV easily passes to infect foetus. Moreover, the expression of HBcAg in the placenta tissue shows that the infection and replication of HBV is a risk factor of the foetus infection. Treatment may inhibit cccDNA replication in the infected placental tissue, which reduce the risk of foetus infection.

关 键 词：乙型肝炎共价环状DNA 原位聚合酶链反应 垂直传播 免疫组织化学 

分 类 号：R1[医药卫生—公共卫生与预防医学]