300例HBsAg阳性产妇对新生儿乙肝血清学模式和HBV DNA的影响及临床意义  

The Influence and Clinical Significance to the Fetus of Different Serological Patterns in 300 Pregnant Women with Chronic Hepatitis B Virus Infection

作　　者：卞成蓉 刘超[2] 宋英伟 刘佳 赵静 宋丽娟 张岚 赵利利 刘乐 李想 毛远丽 李伯安 BIAN Chengrong;LIU Chao;SONG Yingwei;LIU Jia;ZHAO Jing;SONG Lijuan;ZHANG Lan;ZHAO Lili;LIU Le;LI Xiang;MAO Yuanli;LI Bo′an(Center of Clinical Laboratory,the Fifth Medical Center,Chinese PLA General Hospital,Beijing 100039,China;State Key Laboratory ofCardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease,Chinese Academy of Medical Sciences and Peking UnionMedical College, Beijing 100037, China;Department of Blood Transfusion,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Blood Transfusion,the Fifth Medical Center,Chinese PLA General Hospital,Beijing 100039,China;Brain Science Research Center,Yanbian University, Yanji 133000,China)

机构地区：[1]中国人民解放军总医院第五医学中心临床检验医学中心,北京100039 [2]中国医学科学院北京协和医学院国家心血管病中心阜外心血管病医院心血管疾病国家重点实验室,北京100037 [3]中国人民解放军总医院第一医学中心输血科,北京100853 [4]中国人民解放军总医院第五医学中心输血科,北京100039 [5]延边大学脑科学研究中心,吉林延吉133000

出　　处：《标记免疫分析与临床》2020年第11期1852-1856,1861,共6页Labeled Immunoassays and Clinical Medicine

基　　金：基于核酸检测技术的病毒性肝炎、艾滋病、结核等传染病检测系列产品的研发及应用(编号:2020ZX10001002)。

摘　　要：目的针对母婴垂直传播,分析300例HBsAg阳性乙肝产妇所产新生儿的乙肝血清学标志物的表现模式及HBV DNA拷贝数,探讨其对宫内胎儿的影响及临床意义;同时,根据婴儿出生7个月后的随访结果,进一步探讨抗病毒药物对乙肝产妇母婴阻断的效果。方法回顾300例HBsAg阳性孕妇及其所生婴儿的血清乙肝标志物和HBV DNA拷贝数,对结果进行统计学分析。同时,对出生7个月后新生儿进行随访,收集其乙肝五项和HBV DNA检测结果,对结果进行汇总和统计学分析。结果300例HBsAg阳性乙肝产妇所产新生儿的乙肝五项模式共有13种。其中,179例HBsAg(+)HBeAg(-)产妇所产新生儿的乙肝五项模式有9种,121例HBsAg(+)HBeAg(+)产妇所产新生儿的乙肝五项模式有11种。新生儿血清中的HBeAg水平与其母亲的HBV DNA高拷贝数和强传染性有关。在HBsAg阳性母亲中,血清HBV DNA阳性的母亲所生婴儿被感染的危险度高于血清HBV DNA阴性的母亲所生婴儿,两组比较差异有统计学意义。HBV DNA阳性的产妇自28周起开始服用药物(替比夫定/富马酸替诺福韦二吡呋酯)组(69例)和未服药组(127例)其所产新生儿HBV DNA比较,差异具有统计学意义。结论HBsAg阳性孕妇所生婴儿的乙肝血清学标志物模式具有多样性。孕妇HBeAg和HBV DNA阳性是宫内胎儿HBV感染的高危因素。乙肝孕妇怀孕28周服用抗病毒药物可显著降低新生儿感染HBV的风险。Objective To investigate the influence and clinical significance to the intrauterine fetus of carrying condition in HBV virus and serological patterns among pregnant women with chronic hepatitis B virus infection,and to further explore the effect of blocking by the antiviral drugs against hepatitis B virus in pregnant women from the follow-up results of infants born after 7 months.Methods We reviewed the HBV serum markers and HBV DNA copies of 300 cases of pregnant women,whose HBsAg were positive in serum,and their newborn infants.Meanwhile,the results of newborn infants after birth and 7 months were analyzed statistically.Results There were 13 kinds of hepatitis B serum marker models in the fetus,born in 300 cases of hepatitis B pregnant woman.Among them,there were 9 kinds of HBV serological patterns in 179 newborns born in HBsAg(+)HBeAg(-)hepatitis B pregnant mothers,and 11 kinds of HBV serological patterns in 121 newborns born in HBsAg(+)HBeAg(+)hepatitis B pregnant mothers.The more HBeAg content in motherly serum,the more HBV DNA copies in their babies′serum,and the higher infectious.For the pregnant women with positive HBsAg,the newborn infants had the higher infected risk from the mothers who were HBV DNA positive.Comparisons of two groups showed an extremely significant significance.There was significant difference of HBV DNA copies in their babies′serum between the drug group(69 cases),which took telbivudine or tenofovir dipivoxil fumarate among the HBV DNA positive pregnant women from 28 weeks,and the non-drug group(127 cases).Conclusion The model of hepatitis B serum markers shows a diversity in newborn infants,born in the pregnant women with HBsAg positive.Both of positive HBeAg and HBV DNA in pregnant women are risk factors to fetal HBV infection.Meanwhile,by taking antiviral drugs at 28 weeks,the pregnant women could significantly reduce the risk of HBV infection in newborns.

关 键 词：乙型肝炎病毒 母婴传播 血清标志物 

分 类 号：R512.62[医药卫生—内科学]