乙型肝炎病毒宫内感染免疫失败机制的探讨  

Mechanism of Immunization Failure of HBV in Intrauterine Infection

作　　者：鞠丽丽[1] 余敏敏[1] 季莹[1] 吴凯华[1] 

机构地区：[1]东南大学医学院附属南京第二医院,江苏南京210003

出　　处：《实用妇产科杂志》2010年第8期625-628,共4页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探索乙型肝炎病毒宫内感染免疫失败的机制,为孕期抗病毒治疗和新生儿免疫治疗提供理论依据。方法:将入选的86例乙肝表面抗原(HBsAg)阳性孕妇,按HBV-DNA水平分为阴性组、低病毒载量组、高病毒载量组,将婴儿分为宫内感染组和非宫内感染组。对86例新生儿实施联合免疫,在出生时检测T细胞亚群和乙肝病毒标志物(HBVm)及HBV-DNA定量,1月龄、12月龄时复查HBVm及HBV-DNA定量,比较婴儿的T细胞亚群和免疫情况。结果:宫内感染组新生儿CD4+绝对数计数、百分数和CD4+/CD8+比值均低于非宫内感染组(P<0.05),而CD8+绝对数计数和百分数高于非宫内感染组(P<0.05);宫内感染组婴儿抗HBs平均滴度197.78±38.56U/ml低于非宫内感染组384.43±62.93U/ml(P<0.05),宫内感染组免疫失败率30.00%高于非宫内感染组1.52%(P<0.05);高病毒载量组孕妇的婴儿宫内感染率(37.50%)和免疫失败率(12.50%)分别高于低病毒载量组的9.09%和4.55%(P<0.05)。结论:宫内感染HBV婴儿可能存在T细胞亚群比例失调,同时对乙肝疫苗的反应性降低;孕期HBV-DNA高载量是宫内感染免疫失败的重要原因。Objective：To explore the mechanism of immunization failure of hepatitis B virus （HBV） in intrauterine infected children so as to provide a theory foundation to immune intervention in infants and antiviral therapy during pregnancy. Methods ：86 pregnant women with positive hepatitis B surface antigen （HBsAg） were divided into 3 groups including negative group, low virus load group, high virus load group according to their HBV-DNA level. Their infants were divided into intrauterine infection group and non-intrauterine infection group. All infants accepted combined immunization . Their T-Lymphocyte subsets were detected at birth and HBV marker （ HBVm）, HBV-DNA were detected at birth, 1 month and 12 months after delivery. The T-Lymphocyte subsets and immunization conditions of the infants were compared. Results：The CD4^＋ T-Lymphocyte count, percentage and ratio of CD4^＋/CD8^＋ were lower in the intrauterine infection group than that in the non-intrauterine infection group （ P 〈 0.05）. While the CD8 ^＋ T-Lymphocyte count and percentage were higher in the intrauterine infection group than that in the non-intrauterine infection group （ P 〈 0.05）. The average titer of anti-HBs in intrauterine infection group was lower（197.78 ±38.56 U/ml vs 384.43±62.93 U/ ml, P〈O. 05） in the intrauterine infection group than that in the non-intrauterine infection group （P〈 0. 05）. The incidence of immunization failure in the intrauterine infection group was much higher than that in the non- intrauterine infection group（30.00% vs 1.52%, P 〈 0.05） . The incidence of intrauterine infection and immunization failure in high virus load group was 37.5% and 12.5% respectively, which were much higher than those in low virus load group （9.09% and 4.55%, P 〈 0.05）. Conclusions： The intrauterine infection of HBV may be related to disproportion of T-Lymphocyte subsets and the low reactivity to HBV vaccine. High virus load of HBV-DNA during pregnancy is the main reason of immunization fai

关 键 词：乙型肝炎病毒 宫内感染 免疫失败 T淋巴细胞亚群 

分 类 号：R714[医药卫生—妇产科学]