脐血乙型肝炎病毒血清学标记物诊断宫内感染的局限性  

Limitation of hepatitis B markers in cord blood for diagnosing intrauterine infection of hepatitis B virus

作　　者：刘景丽[1] 刘兰华[3] 徐陈瑜 陈廷美 徐飚[3] 陈洁[2] 胡娅莉[2] 周乙华[1] 

机构地区：[1]南京大学医学院附属鼓楼医院科研部,210008 [2]南京大学医学院附属鼓楼医院妇产科,210008 [3]江苏省泰兴市人民医院妇产科 [4]江苏省镇江市妇幼保健院妇产科

出　　处：《中华围产医学杂志》2015年第11期812-817,共6页Chinese Journal of Perinatal Medicine

基　　金：江苏省母胎医学重点学科建设项目（XK201102）;江苏省卫生计生委科研课题（H201537）;南京市第一层次卫生人才项目（QRX111024）

摘　　要：目的探讨脐血乙型肝炎病毒（hepatitisBvirus，HBV）血清学标记物在诊断HBV宫内感染中的应用价值。方法2011年10月8日至2013年5月31日，在南京大学医学院附属鼓楼医院、江苏省泰兴市人民医院和镇江市妇幼保健院分娩的孕妇中，纳入278例乙型肝炎表面抗原（hepatitisBsurfaceantigen，HBsAg）阳性、妊娠期未接受抗病毒治疗、无丙型肝炎病毒或人类免疫缺陷病毒感染的孕妇（其中3例双胎）。281例新生儿生后12h内均进行被动免疫及主动免疫。孕妇分娩后立即采集脐血，分娩后2d内采集外周血，婴儿7～12月龄随访时采集外周血。采用荧光定量聚合酶链反应技术检测血清HBVDNA，检测下限为10^2U／ml。采用酶联免疫吸附试验定性检测HBsAg、乙型肝炎表面抗体（hepatitis Bsurfaceantibody，抗HBs）、乙型肝炎e抗原（hepatitis Beantigen，HBeAg）、乙型肝炎e抗体（hepatitis Beantibody，抗HBe）和乙型肝炎核心抗体（hepatitisBcoreantibody，抗-HBc），以及抗HBcIgM。分析7-12月龄时的婴儿随访率，母血、脐血及婴儿的HBV血清标记物水平，婴儿慢性HBV感染率，以及脐血HBVDNA、抗-HBcIgM水平与HBV宫内感染的关系。结果7～12月龄时婴儿随访率为76．2％（214／281）。71例HBeAg阴性孕妇分娩新生儿71例，其中8例（11．3％，8／71）脐血HBVDNA阳性；随访到56例，其中7例（12．5％，7／56）脐血HBVDNA阳性，但7～12月龄时，54例（96．4％，54／56）抗-HBs阳性，HBsAg和抗-HBc均为阴性，无一例HBV感染。207例HBeAg阳性孕妇分娩新生儿210例，其中86例（41．0％，86／210）HBVDNA阳性；随访到158例，其中38例（24．1％，38／158）脐血HBVDNA和HBsAg同时阳性；但7～12月龄时仅6例（3-8％，6／158）HBsAg、HBeAg和抗-HBc同时阳性，HBVDNA为1．55×1071．51×10^9U／ml，诊断慢性HBV感染。脐血HBVDNA≥10^5U／ml者中随访到7例，其中4例7～12月龄时未感染�Objective To investigate the role of hepatitis B virus （HBV） DNA and hepatitis B core antibody （anti HBc） IgM in cord blood for diagnosis of HBV intrauterine infection. Methods FromOctober 8, 2011 to May 31, 2013, a total of 278 pregnant women with positive hepatitis B surface antigen （HBsAg） were enrolled from Nanjing Drum Tower Hospital, Taixing People＇s Hospital, and Zhenjiang Metarnal and Child Hospital. None of them had received antiviral therapy, co infection with hepatitis C virus or human immunodeficiency virus. All 281 newborns （three pairs of twins） of them had been vaccinated against hepatitis B and received hepatitis B immunoglobulin （HBIG） within 12 h after birth. Serum samples of HBsAg-positive women at 2 days after delivery and cord sera of their neonates as well as sera of these children followed up at the age of 7-12 months were collected. HBV DNA levels were detected by fluorescent quantitative polymerase chain reaction, with the lower detection limit of 102 U/ml. HBV serologic markers and anti-HBc IgM were examined by enzyme linked immunosorbent assay. HBsAg and hepatitis B e antigen （HBeAg） were quantified with Abbott reagents. Then we analyzed the rate of infants followed-up, the level of HBV markers, and the relationship of HBV DNA, anti HBc IgM and HBV intrauterine infection. Results Totally 214 （76.2%） infants were followed up at the age of 7-12 months. Of the 71 cord blood samples of HBeAg-negative mothers, eight （11.3%） had detectable HBV DNA; among the 56 followed-up infants, seven （9.9%） were positive for HBV DNA, while 54 were positive for anti-HBs and negative for both HBsAg and anti-HBc. None of the above 56 infants were positive for HBsAg, HBeAg, or anti-HBc. Of the 210 cord blood samples of the 207 HBeAg-positive mothers, 86 （41.0%） had detectable HBV DNA. Of the 158 infants who attended the follow-up, 38 （24.1%, 38/158） were positive for both HBV DNA and HBsAg, while only six （3.8%, 6/158） were positive for HBsAg, HBeAg, and anti-

关 键 词：乙型肝炎病毒 乙型肝炎 传染性疾病传播 垂直 乙型肝炎核心抗原 生物学标记 胎m 

分 类 号：R714.251[医药卫生—妇产科学]