HBsAg阳性孕妇胎盘HBV感染状况及危险因素  

Study on HBV infection state and risk factors of HBsAg-positive pregnant women placental tissue

作　　者：李铁钢[1] 王素萍[1] 李淑珍[1] 王效军[1] 冯永亮[1] 薛淑莲[1] 双洁玉[2] 渠轶群[2] 

机构地区：[1]山西医科大学流行病学教研室,太原030001 [2]太原市传染病医院妇产科

出　　处：《中国公共卫生》2005年第2期165-166,共2页Chinese Journal of Public Health

基　　金：家自然科学基金资助项目 (30 0 70 699) ;山西省自然科学基金 (2 0 0 0 1 0 63)

摘　　要：目的　探讨HBsAg阳性孕妇胎盘乙型肝炎病毒 (HBV)感染状况及其危险因素。 方法　采用ELISA检测孕妇血清HBeAg ;巢式PCR检测孕妇及新生儿血清HBVDNA ;免疫组化ABC法检测胎盘中的HBsAg ;非条件Lo gistic回归模型分析胎盘HBV感染的危险因素。 结果　受检的 2 0 5例胎盘中有 4 1例存在不同程度的HBV感染 ,并且蜕膜细胞 (DC)、滋养层细胞 (TC)、绒毛间质细胞 (VMC)和绒毛毛细血管内皮细胞 (VCEC)阳性率呈逐层下降趋势(趋势 χ2 =9 38,P <0 0 0 5 ) ,阳性率分别为 2 0 0 0 %(41 / 2 0 5 ) ,1 8 0 5 %(37/ 2 0 5 ) ,1 4 1 5 %(2 9/ 2 0 5 )和 1 0 2 4 %(2 1 /2 0 5 ) ;胎盘HBV感染的危险因素为产前注射高效价免疫球蛋白 (HBIG) 3次以上和母亲血清HBVDNA阳性 ,OR值分别为 0 2 1和 4 77。结论　HBV可感染胎盘各层细胞 ;HBV经胎盘及胎儿的主要途径是经血和 (或 )细胞传递方式实现 ;胎盘屏障在一定程度上对胎儿有保护作用 ;母亲血清HBVDNA阳性是胎盘感染的危险因素 ,产前注射HBIG可预防HBV胎盘感染 ,从而降低宫内感染的隐患。Objective To explore HBsAg-positive pregnant women placentas Hepatitis B virus(HBV)infection state and risk factors. Methods HBeAg in pregnant women were determined by enzyme-linked immunosorbent assay(ELISA).HBsAg in placenta were detected by immunohistochemistry ABC.HBV DNA in pregnant women and their newborns were determined by nested polymerase chain reaction(nPCR).Risk factors of placenta were infected HBV were analyzed by Logistic regression model.Results 41?of?205?placenta being infected by HBsAg.HBV infection rates decreased gradually from the maternal side to the fetal side(trend test χ 2=9.38,P<0.005)in the placental cell layers.Maternal decidual cells(20.00%)>trophoblastic cells(18.05%)>villous mesenchymal cells(14.15%)>villous capillary endothelial cells(10.24%)Risk factors of placenta being infected HBsAg included antepartum injection hepatitis B immune globulin(HBIG)over thrice(OR=0.21)and HBV DNA positive in maternal serum(OR=4.77).Conclusion HBV can infect placental tissue and probably duplicate in it .Main approach of HBV invasiving newborns via placenta is mediated by “cell transfer'.Placental barrier can offer conservancy effect on fetus to some extent.HBV DNA positive in maternal serum is the risk fator of placental infection.Antepartum injection HBIG over thrice can effectively protect placenta from HBV infection and thereby decrease hidden danger of HBV interuterine infection.

关 键 词：乙型肝炎病毒 胎盘 危险因素 

分 类 号：R512.62[医药卫生—内科学] R174.6[医药卫生—临床医学]