乙肝病毒父婴垂直传播感染率的临床调查

目的 调查研究乙型肝炎病毒(hepatitis B virus,HBV)父婴垂直传播感染率的情况.方法 以56对感染HBV的父亲而母亲无HBV标志物的夫妇新生儿脐血做研究组,以10对均不携带HBV的夫妇新生儿脐血做为对照组,分别做HBV PCR检测.结果 在研究组的脐血标本中检出2例HBV DNA阳性标本,而这2例新生...     

Prevention of vertical transmission of hepatitis B virus infection

Hepatitis B virus (HBV) is the leading cause of chronic viral hepatitis. Annually, almost two million children younger than 5 years acquire the infection, mostly through vertical or horizontal transmission in early life. Vertical transmission of HBV is a high efficacy phenomenon ranging, in the absence of any preventive interventions, from 70% to 90% for hepatitis e antigen positive mothers and from 10% to 40% for hepatitis e antigen-negative mothers. Maternal viraemia is a preeminent risk factor for vertical transmission of HBV. Maternal screening is the first step to prevent vertical transmission of HBV. Hepatitis B passive and active immunoprophylaxis at birth together with antiviral treatment of highly viraemic mothers are the key strategies for global elimination of HBV infection. Strategies are needed to promote implementation of birth-dose vaccination and hepatitis B immunoglobulins in low- and middle-income countries where the prevalence of the infection is at the highest.     

Detection and direct sequencing of hepatitis B virus genome by DNA amplification method

Hepatitis B virus (HBV) DNA was detected with amplification by the polymerase chain reaction method. Cloned HBV DNA equivalent to one virus genome (3 x 10(-6) pg) was detectable by ethidium bromide staining after 50 cycles of polymerase chain reaction. By applying this method, presence of HBV DNA was studied in 23 hepatitis B surface antigen (HBsAg)-positive and 11 HBsAg-negative sera from patients with chronic liver disease. Hepatitis B virus DNA was positive in 8 of 8 hepatitis B e antigen (HBeAg)-positive, in 2 of 2 HBeAg- and anti-HBe-negative, and in 12 of 13 anti-HBe-positive sera. Hepatitis B virus DNA was undetectable in all HBsAg-negative sera even with amplification. To confirm specificity, the amplified product was directly sequenced. Sequences around 122nd and 160th codon of HBs gene, which determines subtypes d/y and w/r, respectively, were analyzed. The results were compatible with recent reports regarding the relation between HBV subtypes and HBV DNA sequence at those codons. Hepatitis B virus DNA could be detected at the level of one virion by gene amplification method, and its sequence could be determined by direct sequencing in a few days.     

子宫内传播中乙型肝炎病毒部分S区基因的变异

目的 以丈夫无乙型肝炎病毒（ＨＢＶ）感染标志的４例女性携带者与妻子无ＨＢＶ感染标志的６例男性携带者及子宫内感染ＨＢＶ的胎儿为对象,研究子宫内传播中ＨＢＶ Ｓ区的变异。方法 以双脱氧链末端终止法检测母儿,父儿所携ＨＢＶ Ｓ区４５１－６６０位核苷酸序列。结果 母儿,父儿间同源性９８％－１００％,检出４９１,４９４,５３０,５４６,５８１位点变异致使１１３,１１４,１２６,１３１,１４３位氨基酸替代,其     

不同方案阻断乙肝病毒母婴垂直传播的临床研究

探讨阻断乙型肝炎病毒母婴垂直传播的方法。将122例HBsAg( )孕妇分成四组，HBVac治疗组29例，HBIG组29例。左旋咪唑涂布剂与以上两者联合应用30例。未治疗组34例。均在孕26周开始干预观察，孕妇和新生儿血清HBV标志物（HBVM）检测采用ELISA法，122例孕妇按分娩方式不同分别观察对乙肝病毒母婴垂直传播影响；随访产妇及新生儿HBVM变化。脐血中HBsAg阳性率；HBVac治疗组为17.24%。HBIG治疗组为10.35%。联合治疗组为3.33%。未治疗组为23.53%。在不同的分娩方式中，急症剖宫产新生儿脐血HBsAg阳性率为13.04%，行择期剖宫产者为0，经阴道分娩者为16.67%。携带HBV孕妇于孕晚期给予HBVac,HBIG和左旋咪唑涂布剂联合以上两者治疗后，可有效阻断母婴之间传播。以联合治疗组效果最佳。不同分娩方式也影响传播，剖宫产术有助于阻断HBV母婴传播。     

乙型肝炎病毒母婴传播及其阻断研究的现状与存在问题

HBV可经血液、母婴、性接触等多种途径传播,其中母婴传播是我国HBV传播的主要途径之一.乙型肝炎母婴阻断是指通过产前、产时,产后采取一系列措施对新生儿进行保护以减少感染HBV机会的方法.近年来,HBV的母婴阻断取得了较好效果,总体阻断成功率约在90%以上,但仍有一定的失败率,在相关机制、方案优化等方面仍面临一些亟待解决的问题.     

HBV感染垂直传播阻断研究的现状与问题

乙型肝炎病毒(HBV)感染是严重的公共卫生问题.随着献血管理的加强和乙肝疫苗的逐步推广,HBV感染水平传播的流行势头已经得到遏制,而垂直传播成为导致HBV慢性感染的主要途径之一.HBV感染垂直传播包括母婴传播和父婴传播,以前者为主.传播的途径包括:宫前感染、宫内感染、产程感染、出生后感染.对新生儿联合使用乙肝免疫球蛋白和乙肝疫苗已成为阻断母婴传播的重要措施,但仍有部分病例未能获得有效保护.其中,HBV宫内感染的存在是导致阻断措施失败的重要原因之一.     

Responsiveness to interferon alpha in chronic hepatitis B by presumed vertical transmission

This study was to evaluate responsiveness to IFN-alpha and investigate the benefits of sustained response (SR) in patients who were presumed as being vertically transmitted in Korea. A total of 46 patients of presumed vertical transmission with biopsy-proven HBeAg-positive chronic HBV infection were treated with IFN-alpha and followed. We tried to find the factors associated with SR and compared the cumulative rate of HCC and survival between SR group and non-sustained/non-responder (NSR) group. HBeAg loss was acquired in 35% (16/46) within a year but SR was observed in 22% (10/46). Age <35 years and ALT levels >7xULN were significant favorable factors for SR (OR 0.56, 0.49, 95%CI 0.38-0.82, 0.29-0.81, respectively) (both P<0.05). There were no significant differences of cumulative HCC-free survival (100 vs. 68% at 12 years, P=0.36) and survival (100 vs. 73% at 12 years, P=0.3) between SR group and NSR group. In conclusion, age below 35 years old and serum ALT levels above 7xULN may predict IFN-alpha therapy-induced SR among them, although we cannot affirm the effects on HCC prevention or survival.     

必须重视阻断乙型肝炎病毒母婴传播的研究

乙型肝炎疫苗 (乙肝疫苗 )单独或联合乙型肝炎免疫球蛋白 (HBIG)对乙型肝炎病毒母婴传播的阻断已取得了明显效果。国内外多数研究表明 ,HBIG加乙肝疫苗的阻断效果可达 90 %～ 95 %。但无论采取什么措施 ,总有一小部分阻断失败 ,一般认为这一部分是由于子宫内传播所致 ,因为如果胎儿已经受染 ,出生后再预防就无用了。这一小部分从流行病学看来 ,可能问题不大 ;但从新生儿本身及其家属来说 ,却是一个非常重要的问题。目前绝大多数家庭均遵守一对夫妇只生一个孩子的政策 ,如果这个孩子被HBV感染 ,将给整个家庭以及孩子本人带来无穷无尽的…     

孕期干预阻断乙肝病毒母婴垂直传播效果评价

目的　探讨孕期干预治疗阻断乙型肝炎病毒母婴垂直传播的效果。方法　将 6 0例 HBs Ag/ HBe Ag阳性孕妇分成治疗组 31例 ,对照组 2 9例。治疗组均在孕 2 6周起开始注射乙肝免疫球蛋白 (HBIG)及外用左旋咪唑涂布剂 ,采用 EL ISA法检测孕妇和新生儿血清 HBs Ag、HBAb、Hbe Ag、HBe Ab、HBc Ab,用 PCR电泳和 RT-PCR法测定 HBV- DNA及全长型和顿挫性转录体。分析母婴之间乙肝病毒分子水平上的关系。结果　新生儿外周血中 HBs Ag阳性者 2例 ,宫内感染率为 6 .4 5 %。对照组 4例 ,宫内感染率 13.7%。与对照组比较差异有显著性。 (P<0 .0 1) ,两组都有超过一半的患儿携带顿挫型病毒转录体。结论　携带 HBV孕妇于孕晚期给 HBIG和左旋咪唑涂布剂联合治疗后 ,可有效降低婴儿 HBs Ag和 HBV- DNA携带率     

阻断乙型肝炎病毒母婴传播的研究进展

我国的慢性乙型肝炎病毒（HBV）感染者约有30％～50％是通过母婴传播形成的。接种乙型肝炎（乙肝）疫苗是预防慢性HBV感染及相关肝细胞肝癌的有效手段[1],但现行的免疫措施用于阻断HBV母婴传播时,仍有免疫失败发生。研究接种乙肝疫苗免疫失败的相关因素及机制进而制定相应对策是根除HBV流行的关键。一、现行不同免疫策略的母婴传播阻断效果目前我国主要使用基因重组酵母乙肝疫苗,每次5μg,按0、第1月、第6月     

乙型肝炎病毒垂直传播机制的研究进展

垂直传播是乙型肝炎病毒(HBV)的主要传播途径之一。狭义的垂直传播,指患者的生殖细胞受病毒感染,在受精时由精子或卵细胞作为载体,将病毒基因带入胚胎进而使子代患病。迄今为止,文献中提到的垂直传播多指广义的垂直传播,即感染HBV的父亲和(或)母亲与婴儿之间,经生殖细胞、宫内感染、分娩及产后接触等途径所实现的HBV传播。     

正确应对乙型肝炎母婴传播

HBV感染及慢性化是一个严峻的公共卫生问题,其中HBV母婴垂直传播是最常见的感染途径之一。从母亲怀孕前评估/筛查、孕期干预及对新生儿采取联合免疫等方面概述了HBV母婴垂直传播主要环节存在的危险因素及应对措施,指出妇产科及肝病科医生在解决这个问题上起到最关键的作用。     

Identification of hepatitis B virus indigenous to chimpanzees

Hepatitis B viruses (HBV) and related viruses, classified in the Hepadnaviridae family, are found in a wide variety of mammals and birds. Although the chimpanzee has been the primary experimental model of HBV infection, this species has not been considered a natural host for the virus. Retrospective analysis of 13 predominantly wild-caught chimpanzees with chronic HBV infection identified a unique chimpanzee HBV strain in 11 animals. Nucleotide and derived amino acid analysis of the complete HBV genome and the gene coding for the hepatitis B surface antigen (S gene) identified sequence patterns that could be used to reliably identify chimpanzee HBV. This analysis indicated that chimpanzee HBV is distinct from known human HBV genotypes and is closely related to HBVs previously isolated from a chimpanzee, gibbons, gorillas, and orangutans.     

Endoscopic transmission of hepatitis B virus.

Although transmission of hepatitis B virus (HBV) infection has long been recognised as a potential hazard of gastrointestinal endoscopy, there has been little evidence of direct patient-to-patient cross-infection after such procedures. We wish to report a case of type B viral hepatitis almost certainly acquired at endoscopy from an instrument sterilised in the conventional manner, but which had been used on the previous day on a patient with bleeding oesophageal varices who was incubating type B viral hepatitis.     

Prevention of maternal-infant hepatitis B virus transmission by immunization: the role of serum hepatitis B virus DNA

Sera from 108 HBsAg carrier mothers at delivery and their respective offspring at birth and at 6 months of age were examined for hepatitis B virus DNA by the dot-blot hybridization technique. Hepatitis B virus DNA was detected in 83% of 88 carrier mothers who were HBeAg positive, and in 10% of 20 carrier mothers who were HBeAg negative. All five infants born to HBeAg-positive carrier mothers with hepatitis B virus DNA levels over 80 pg per 10 microliters of serum were infected by hepatitis B virus, in spite of receiving hepatitis B immunization. All 17 infants without hepatitis B immunization who were born to HBeAg and hepatitis B virus DNA-positive carrier mothers developed hepatitis B virus infection. Of 56 infants born to HBeAg and hepatitis B virus DNA-positive carrier mothers and who had received hepatitis B immunization, a higher hepatitis B virus infection rate was found in a group of infants whose sera hepatitis B virus DNA were positive (15/16, 93.8%) than in infants whose sera were negative (17/40, 42.5%) at birth (p less than 0.0005). These data suggest that the assay for hepatitis B virus DNA in sera of HBsAg carrier mothers at delivery or their infants at birth will predict the efficacy of hepatitis B immunization for prevention of maternal-infant hepatitis B virus transmission.