乙肝病毒携带孕妇羊膜腔穿刺术后胎儿宫内感染的风险  

Risk of intrauterine fetal infection in pregnant women infected with HBV after amniocentesis

作　　者：陈映婷[1] 潘丽[1] 苏文[2] 

机构地区：[1]广东珠海市妇幼保健院产科,珠海519000 [2]广东珠海市妇幼保健院检验科遗传所,珠海519000

出　　处：《妇产与遗传（电子版）》2014年第2期36-40,共5页Obstetrics-Gynecology and Genetics (Electronic Edition)

基　　金：珠海市科技计划项目(02196711140710018)

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,HBs Ag)阳性、乙肝病毒e抗原(viral hepatitis B virus e antigen,HBe Ag)阴性组;HBs Ag阳性、HBe Ag阳性组;HBV-DNA<1.0×103cps/ml组;1.0×103-1.0×107cps/ml组;≥1.0×107cps/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≥1.0×107cps/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≥1.0×107cps/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 womeninfected 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 andperipheral blood of 6-month-old infants in 178 cases were detected by using ELISA and real-time PCRmethod. All the cases were divided into two groups, the experimental group(n=41) which pregnant womeninfected with HBV accepted amniocentesis, and the control group(n=137)which the pregnant women infectedwith HBV did not receive amniocentesis. According to the different HBV carrying case and placental locationboth groups are divided into: the hepatitis B virus surface antigen(HBs Ag)-positive, hepatitis B virus e antigen(HBe Ag)-negative group; HBs Ag positive, HBe Ag-positive group; HBV-DNA <1.0 × 103cps/ml group; 1.0 ×103-1.0 × 107cps/ml group; HBV-DNA≥ 1.0 × 107cps/ml group; placenta anterior group; placenta posteriorgroup. The intrauterine fetal infection rate of different HBV carry situations and different placental locations ofboth groups were compared statistical analyzed. Results When HBV-DNA≥1.0 × 107cps/ml, theintrauterine fetal infection rate in the experimental group(50%) was higher than the control group(6.38%), andthe 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 significantdifference(χ2=1.165, P=0.210). Conclusions Therefore, When the pregnant women's blood HBV-DNA≥1.0×107cps/ml, the amniocentesismay increase the risk of intrauterine fetal infection rate, to other cases,the amniocentesis won't increase the risk of intrauterine fetal infectionrate, therefore, it needs to detect and classify the HBV-DNA of pregnant women infected with HBV before prenatal diagnosis, and the scientificguidance of prenatal diagnosis must based on

关 键 词：乙肝病毒携带 羊膜腔穿刺术 宫内感染 

分 类 号：R714.251[医药卫生—妇产科学]