TNF-α-308基因多态性与乙型肝炎母婴传播阻断失败的关联  

Association of TNF-α-308 gene polymorphisms with failure of blocking of mother-to-infant transmission of hepatitis B

作　　者：高稳 马力 潘寒寒 牛水源 袁贝贝 GAO Wen;MA Li;PAN Han-han;NIU Shui-yuan;YUAN Bei-bei(Henan Provincial People's Hospital,Zhengzhou,Henan 450000,China)

机构地区：[1]河南省人民医院公共卫生中心感染性疾病科三病区,河南郑州450000

出　　处：《中华医院感染学杂志》2024年第4期566-570,共5页Chinese Journal of Nosocomiology

基　　金：河南省科技厅科技攻关基金资助项目(232102310182)。

摘　　要：目的探讨肿瘤坏死因子-α(TNF-α)-308基因多态性对乙型肝炎母婴传播阻断效果的影响,并构建风险因素模型.方法回顾性分析2021年1月—2023年1月河南省人民医院收治的895例经过乙型肝炎母婴阻断治疗的孕产妇及其所生婴儿的临床资料,根据治疗效果将免疫阻断失败的纳入A组(61例),免疫阻断成功的纳入B组(834例);分析两组TNF-α-308基因多态性,采用多因素Logistic回归分析法分析乙型肝炎母婴传播阻断失败的危险因素,并构建预测模型,绘制受试者工作特征(ROC)曲线分析其对乙型肝炎母婴传播阻断失败的预测价值.结果相比于B组,A组TNF-α-308 A/A基因型及A等位基因频率更高(P<0.05);A组孕产妇孕前体质量指数(BMI)、产后血清谷丙转氨酶(ALT)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)、IL-4、乙型肝炎e抗原(HBeAg)、乙型肝炎表面抗原(HBsAg)水平及血浆乙型肝炎病毒(HBV)DNA载量均高于B组,产后IL-18低于B组(P<0.05);多因素Logistic回归分析结果显示,乙型肝炎母婴传播阻断失败的危险因素包括孕产妇产后ALT、HBeAg、HBsAg及血浆HBV DNA载量、TNF-α-308 A/A基因型及A等位基因(P<0.05);构建回归方程模型:Logit(P)=-12.032+产后ALT×1.032+HBeAg×0.983+HBsAg×0.673+血浆HBV DNA载量×1.657+TNF-α-308 A/A基因型×0.976+TNF-α-308A等位基因×1.373;ROC曲线显示,当Logit(P)>13.26时,曲线下面积(AUC)值为0.859,95%CI为0.834~0.881,诊断敏感度为70.49%,特异度为87.17%.结论乙型肝炎母婴传播阻断效果与TNF-α-308基因多态性具有密切关系,阻断失败的危险因素包括孕产妇产后血清ALT、HBeAg、HBsAg及血浆HBV DNA载量、TNF-α-308 A/A基因型及A等位基因,据此构建的回归模型具有较高预测价值,临床可给予针对性的预防及治疗措施以改善阻断效果.OBJECTIVE To investigate the effect of tumor necrosis factor-α(TNF-α)-308 gene polymorphism on the effectiveness of mother-to-child transmission interruption of hepatitis B,and to construct a risk factor model.METHODS The clinical data of 895 pregnant women and their newborns who underwent maternal-to-child trans-mission interruption treatment for hepatitis B at Longyou County Central Hospital from Jan.2021 to Jan.2023 were retrospectively analyzed.According to the treatment effect,those who failed immunoblocking were included in group A(61 cases),and those who succeeded in immunoblocking were included in group B(834 cases).The TNF-α-308 gene polymorphism of the two groups was analyzed,and multiple factor logistic regression analysis was used to analyze the risk factors for the failure of mother-to-child transmission blockade of hepatitis B,and a prediction model was constructed,and the receiver operating characteristic(ROC)curve was drawn to analyze its predictive value for the failure of mother-to-child transmission blockade of hepatitis B.RESULTS Compared with group B,group A had a higher frequencies of TNF-α-308 A/A genotype and A allele(P<0.05).Maternal pre-pregnancy body mass index(BMI),postpartum serum alanine transaminase(ALT),C-reactive protein(CRP),interleukin-6(IL-6),interleukin-4(IL-4),hepatitis B e antigen(HBeAg),hepatitis B surface antigen(HBsAg)and plasma hepatitis B virus deoxyribonucleic acid(HBV DNA)load were higher than those in group B,and post-partum serum interleukin-18(IL-18)were lower than those in the group B(P<0.05).The results of multivari-ate logistic regression analysis showed that the risk factors of failure of mother-to-child transmission interruption of hepatitis B included postpartum ALT,HBeAg,HBsAg and plasma HBV DNA load,TNF-α-308 A/A geno-type and A allele(P<0.05).The model of regression equation was constructed as:Logit(P)=-12.032+the level of postpartum ALT×1.032+the level of HBeAg×0.983+the level of HBsAg×0.673+plasma HBV DNA load×1.657+TNF-α-308 A/A genotype×0.97

关 键 词：乙型肝炎病毒 母婴传播 阻断效果 阻断失败 肿瘤坏死因子-α-308 

分 类 号：R512.62[医药卫生—内科学]