血清HBsAg阳性孕妇血清细胞因子水平对HBV母婴传播的影响  

Impact ofserum cytokines on maternal-infant transmission of hepatitis B virus in HBsAg positive women

作　　者：余姣 陈姬秀 薛建亚 张彩虹 Yu Jiao;Chen Jixiu;Xue Jianya(Department of Infectious Diseases,Changhai Hospital affiliated to Naval Medical University,Shanghai 200433)

机构地区：[1]海军军医大学长海医院感染病学教研室,上海市200433

出　　处：《实用肝脏病杂志》2020年第5期630-633,共4页Journal of Practical Hepatology

摘　　要：目的探讨血清干扰素-γ(IFN-γ)、白细胞介素-4(IL-4)和IL-10水平对乙型肝炎病毒(HBV)母婴传播的影响。方法2017年8月~2019年7月我院诊治的126例血清HBsAg阳性孕妇和55例健康孕妇,采用ELISA法检测孕妇和新生儿血清IFN-γ、IL-4、IL-10水平。采用受试者工作特征(ROC)曲线和Logistic回归模型分析孕妇外周静脉血细胞因子水平对HBV母婴传播的影响。结果本组发生HBV宫内感染15例,自宫内未感染者中选择30例作为对照,结果宫内感染组孕妇外周静脉血IFN-γ水平为(681.3±141.6)pg/ml,IL-10水平为(62.3±11.4)pg/ml,显著低于宫内未感染组【分别为(992.6±192.3)pg/ml和(68.5±12.8)pg/ml】或对照组【分别为(1040.4±48.1)pg/ml和(73.7±2.6)pg/ml,P<0.05】,而血清IL-4水平为(68.1±22.9)ng/L,显著高于宫内感染组或对照组【分别为(49.2±15.3)ng/L和(38.9±7.2)ng/L,P<0.05】;三组新生儿脐静脉血三个细胞因子水平无显著性差异(P>0.05);ROC分析显示,孕妇外周静脉血IFN-γ预测HBV母婴传播的曲线下面积(AUC)为0.877(95%CI:0.810~0.945),诊断的截断点为≤782.36 pg/ml,其敏感度为100.0%,特异度为69.4%。结论HBV感染孕妇存在免疫功能调节紊乱,检测血清IFNγ、IL-4和IL-10等细胞因子水平可作为评估HBV母婴传播的观察指标,能为临床确定防治措施提供参考信息。Objective The aim of this study was to investigate the impact of serum interferon-γ(IFN-γ),interleukin-4(IL-4)and IL-10 levels on maternal-infant transmission of hepatitis B virus(HBV)in HBsAg positive women.Methods 126 pregnant women with serum HBsAg positive and 55 healthy pregnant women were recruited in our hospital from August 2017 through July 2019,and IFN-γ,IL-4 and IL-10 levels in women’s sera and in neonatal umbilical vein blood were assayed by ELISA.The receiver operating characteristic(ROC)curve and multivariate Logistic regression model were applied to analyze the risk factors affecting HBV mother-to-child transmission.Results Out of our series,the mother-to-child transmission occurred in 15 cases,and 30 cases from 111 women without mother-to-child transmission were selected for control;serum level of IFN-γin intrauterine infection group was(681.3±141.6)pg/ml,and serum level of IL-10 was(62.3±11.4)pg/ml,both significantly lower than[(992.6±192.3)pg/ml and(68.5±12.8)pg/ml,P<0.05]in intrauterine non-transmited group or[(1040.4±48.1)pg/ml and(73.7±2.6)pg/ml,P<0.05]in the control,while serum IL-4 level was(68.1±22.9)ng/L,which was significantly higher than[(49.2±15.3)ng/L or(38.9±7.2)ng/L,respectively,P<0.05]in women without intrauterine transmission or in healthy women;newborn umbilical vein blood cytokine levels in the three groups were not significantly different(P>0.05);ROC showed that the AUC for predicting mother-to-infant transmission by serum IFNγlevels in pregnant women was 0.877(95%CI:0.810-0.945),the cut-off value was≤782.36 pg/ml,the diagnostic sensitivity was 100.0%,and the specificity was 69.4%.Conclusion There is a immune function regulation disorders in pregnant women with HBV infection and the detection of serum IFNγ,IL-4 and IL-10 levels might be used as an indicator to evaluate the risk of mother-to-child transmission of HBV,and provide information for clinical prevention and treatment measures.

关 键 词：乙型肝炎 母婴传播 干扰素-Γ 白细胞介素-4 白细胞介素-10 宫内感染 

分 类 号：R714.251[医药卫生—妇产科学]