孕妇及胎儿乙型肝炎病毒DNA的检测及意义  

The significance of HBV markers in cells and tissues of pregnant women and fetuses at different pregnancy stages.

作　　者：杨淑丽[1] 王宇明[1] 刘俊[1] 汤勃[1] 王永刚[1] 

机构地区：[1]第三军医大学西南医院全军感染病研究所,重庆400038

出　　处：《现代妇产科进展》2004年第4期287-290,共4页Progress in Obstetrics and Gynecology

基　　金：国家自然科学基金资助项目(30230320)

摘　　要：目的定量检测乙型肝炎病毒(HBV)DNA阳性孕妇及其胎儿血清、PBMCs、胎盘、胎肝组织中的HBVDNA,探讨HBV宫内传播与宫内感染的可能途径以及孕妇HBV含量与宫内传播发生的量化关系。方法用PCR荧光定量分析法筛选血清HBVDNA阳性的不同孕龄孕妇,定量检测孕妇及其流产胎儿血清、PBMCs、胎盘、胎肝组织中的HBVDNA;对阳性胎肝组织进行HBVDNA原位杂交;对阳性PBMCs检测HBVcccDNA。结果21例血清HBVDNA阳性的孕妇中,11例PBMCsHBVDNA检测阳性,其中9例HBVcccDNA检测为阴性,而胎儿PBMCsHBVDNA检测均为阴性。母血HBVDNA含量不同数量级之间胎盘、胎肝HBVDNA阳性率差异有显著性(P=0.0001,P=0.001)。HBVDNA原位杂交检测显示,2例胎肝细胞内见阳性染色,相应的胎肝组织、胎儿脐血、胎盘组织PCR检测均为HBVDNA阳性。结论HBV宫内传播经胎盘发生,孕妇PBMCs内的HBV不会发生宫内传播;母血HBVDNA含量在106拷贝/ml及以上时,胎盘感染HBV的危险性显著增加,母血HBVDNA含量在107拷贝/ml及以下时,胎肝感染HBV的危险性显著降低。Objective:To analyze the possible route of intrauterine transmission,the relationship between intrauterine transmission and HBV loads in serum of pregnant women by testing HBV DNA in maternal and fetal cells and tissues.Methods:HBV DNA was tested by PCR fluorescence quantitative analysis in the serum and PBMCs of maternal and fetal serum,PBMCs,placental tissues and fetal liver tissues;then hybridization in situ was carried on those liver tissues positive for HBV DNA;and HBV cccDNA was tested by PCR in PBMCs positive for HBV DNA.Results:21 cases positive for HBV DNA by PCR analysis were selected,and 11 cases were HBV DNA positive in maternal PBMCs of which 9 cases were HBV cccDNA positive,while none was HBV DNA positive in fetal PBMCs.Different level of HBV DNA loads in maternal serum resulted in great difference of HBV infection in placental and fetal liver tissues(P was 0.0001 and 0.001 respectively).Hybridization in situ for HBV DNA showed positive dyeing in hepatocytes in two fetal liver tissues,meanwhile the corresponding fetal liver tissues,fetal serum and placental tissues were all HBV DNA positive. Conclusion:Intrauterine transmission of HBV occurs by route of placenta,and HBV in maternal PBMCs unlikely cause intrauterine transmission.When HBV DNA loads are on or above the level of 10 6 copies/ml in maternal serum samples,the possibility of HBV infection in placental tissues is greatly increased,and when HBV DNA loads are on or under level of 10 7 copies/ml in maternal serum samples,the possibility of HBV infection in fetal liver tissues is greatly decreased.

关 键 词：肝炎病毒 乙型 宫内传播 宫内感染 

分 类 号：R714.251[医药卫生—妇产科学]