Vertical transmission of hepatitis C virus: A tale of multiple outcomes

Globally, hepatitis C virus (HCV) infection affects approximately 130 million people and 3 million new infections occur annually. HCV is also recognized as an important cause of chronic liver disease in children. The absence of proofreading properties of the HCV RNA polymerase leads to a highly error prone replication process, allowing HCV to escape host immune response. The adaptive nature of HCV evolution dictates the outcome of the disease in many ways. Here, we investigated the molecular evolution of HCV in three unrelated children who acquired chronic HCV infection as a result of mother-to-child transmission, two of whom were also coinfected with HIV-1. The persistence of discrete HCV variants and their population structure were assessed using median joining network and Bayesian approaches. While patterns of viral evolution clearly differed between subjects, immune system dysfunction related to HIV coinfection or persistent HCV seronegativity stand as potential mechanisms to explain the lack of molecular evolution observed in these three cases. In contrast, treatment of HCV infection with PegIFN, which did not lead to sustained virologic responses in all 3 cases, was not associated with commensurate variations in the complexity of the variant spectrum. Finally, the differences in the degree of divergence suggest that the mode of transmission of the virus was not the main factor driving viral evolution.     

3536例健康体检者丙型肝炎病毒感染状况的调查分析

目的:了解湛江市HCV感染状况及探讨丙型肝炎感染相关因素。方法:抽取健康体检者3536例,检测丙型肝炎病毒抗体(Anti-HCV)、丙氨酸转氨酶(ALT),对HCV抗体阳性标本再作HCV-RNA检测。结果:3536份样本中HCV抗体阳性33例(9.08‰),男性26例(7.15‰),女性7例(1.92‰),男性HCV抗体检测阳性率比女性高(χ2=11.04,P<0.01);33例HCV抗体阳性标本中12例(男11例,女1例)标本HCV-RNA阳性,9例(男性8例,女性1例)标本ALT升高。结论:HCV抗体感染率不高,感染途径及易感染途径有待研究;重视丙型肝炎病毒的危害性,开展HCV抗体普查,及早发现丙型肝炎及控制感染源,切断传播途径,防止丙型肝炎病毒的蔓延。     

The prevalence of HCV infection in a cohort of pregnant women, the related risk factors and the possibility of vertical transmission

The prevalence of antibodies for one or more HCV antigens was 2.3% of 1,347 mothers at childbirth. Compared with the principal factors studied, the presence of antibodies was more frequent in women who were carriers of HIV infection (3/3), in those who had suffered liver diseases (5/37) or who had had transfusion (3/25). This was as opposed to women who did not have any risk factor (p < 0.001). The prevalence of HCV-RNA was 1.3%; in relation to the antibody state, such a condition was more frequent in subjects with antibodies for 3 or 4 antigens (about 80%) compared with those who were positive for 1 or 2 antigens. HCV-RNA of the same genotype as the mother (type 1; 1a) was also found in the funicular blood of 2 of the 18 babies born to mothers who were positive for HCV-RNA. In the course of the follow-up (from the 3rd to the 18th month) the viral RNA was not found in any of the babies, nor was it found in the 2 who were positive at birth. Even the antibodies gradually disappeared, although slowly. At the 10th month, 91% of the babies resulted as having no antibodies and at the 18th month none of the babies resulted as having antibodies. Breast-feeding also appeared to have no influence on the transmission of the infection; out of 18 viremic mothers indeed 12 (67%) breast-fed their babies.     

加强孕产妇乙型肝炎标志物检测阻断乙型肝炎病毒母婴传播

目的了解孕产妇乙型肝炎标志物现状,为阻断乙型肝炎病毒母婴传播提供科学依据。方法用酶联免疫法对3675名孕产妇进行乙型肝炎标志物检测,并对乙型肝炎标志物模式进行统计分析。结果 3675份检测标本中乙型肝炎标志物全阴性的1438份,占39.13%,乙型肝炎标志物结果有阳性项的2237份,占60.87%;通过对2237份乙型肝炎标志物阳性检测结果统计分析共得出17种模式,其中模式1(抗-HBs+)出现率为43.76%,模式4(HBsAg+、抗-HBc+、抗-HBe+)出现率为9.92%,模式5(HBsAg+、抗-HBc+、HBeAg+)的出现率为6.21%,模式11(HBsAg+、HbeAg+)的出现率为0.67%,模式12(HBsAg+)的出现率为0.31%。结论模式5、11、12的孕产妇是阻断乙型肝炎病毒母婴传播的重点目标。     

260例乙型肝炎病毒感染孕妇母婴垂直传播中相关因素

目的:探讨乙型肝炎病毒(HBV)感染孕妇在母婴垂直传播中的相关因素。方法:对孕10个月分娩的260例HBV感染孕妇的资料进行回顾性分析,观察新生儿脐血的HBVM模式及其与母亲模式的关系。采用化学发光法对产前孕妇进行HBVM免疫学标志联合测定,分娩后新生儿取脐血检测HBVM免疫学测定。结果:①乙肝表面抗原(HBsAg)阳性母亲的新生儿脐血HBsAg(和或HBeAg)阳性率34.23%(89/260),其中58例大三阳者新生儿脐血HBsAg(和或HBeAg)阳性率高达82.76%(48/58),202例小三阳者新生儿脐血HBsAg(和或HBeAg)阳性率达20.30%(41/202)。②89例新生儿感染者中,阴道顺产者有44例,剖宫产者有45例。③新生儿所出现的抗体阳性结果几乎都是其母亲所具有的抗体阳性结果。结论:HBeAg阳性是母婴垂直传播HBV的重要因素,剖宫产并不能降低HBsAg阳性母亲的新生儿脐血HBsAg(或HBeAg)阳性率。新生儿体内的抗体几乎全部来自于母体。     

HBsAg阳性孕妇对预防乙型肝炎病毒母婴传播知识知晓率的调查

目的调查乙型肝炎表面抗原（hepatitisBsurfaceantigen,HBsAg）阳性孕妇对预防乙型肝炎病毒（hepatitisBvirus,HBV）母婴传播知识的知晓率。方法以2012年2～7月在南京鼓楼医院进行产前检查的孕妇为调查对象,发放“预防乙肝母婴传播知识调查表”,调查其对HBV相关知识的知晓率,重点调查HBsAg阳性孕妇对HBV母婴预防知识的知晓率。结果共发放问卷465份,收回有效问卷374份（80．4％）,其中HBsAg阴性者221份（59．1％）,HBsAg阳性者153份（40．9％）。HBsAg阳性者中,96．1％知晓HBV有传染性,但仅49．7％能正确回答其传播方式;84．3％清楚HBV可以预防,但仅58．2％知道疫苗正规接种应包括3针;88．9％知其子女易感,45．1％因此有延迟怀孕的想法,仅20．9％知道必须同时给其新生儿接种乙肝疫苗和注射乙肝免疫球蛋白（hepatitisBimmuneglobulin,HBIG）以防止母婴感染;分别有45．8％和23．5％错误地认为剖宫产和人工喂养可以有效防止母婴传播。结论HBsAg阳性孕妇对预防乙肝母婴传播知识的知晓率不高,应制订相应的宣教措施,提高孕妇对合理预防HBV母婴传播的知晓率。     

云南省孕产妇乙型肝炎病毒感染现状调查

目的 了解云南省住院分娩孕产妇HBV感染状况.方法 对云南省16个州市129个县范围内2011年l-6月孕产妇进行HBV血清学5项指标筛查,阳性者采集静脉血3 mL进行HBV DNA定量检测,同时进行问卷调查采集孕产妇年龄、居住地及文化程度等信息,比较不同年龄组、居住地、文化程度及感染模式孕产妇HBV DNA水平的差异.结果 调查共筛查235 032人,HBV感染率为2.28％(5 364例),获得合格血液样本4 308份,样本采集率为80.31％;15～34岁占91.71％(3 951人),农村居民占80.52％(3 469人),高中(中专)及以下学历占93.03％(4 008人).4 308份血液样本共检测出18种感染模式,其中模式1(HBsAg、HBeAg、抗-HBc项阳性)和模式2(HBsAg、抗-HBe、抗-HBc项阳性)分别占38.74％(1 669例)和45.57％(1 963例);模式4(HBsAg、抗-HBc项阳性)和模式9(HBsAg、HBeAg项阳性)分别占10.17％(438例)和2.16％(93例).不同年龄组孕产妇HBV感染模式1、模式2、模式4和模式9构成比的差异均有统计学意义(χ2=240.76,P＜0.01;X2=203.27,P＜0.01;χ2-=12.40,P＜0.01;x2=10.18,P＜0.05).15～24岁组以模式1感染为主,占52.19％(918/1 759);25～34岁组35～51岁组均以模式2感染为主,分别占52.24％(1 145/2 192)和64.43％(230/357).农村孕产妇模式1感染率为40.53％(1 406/3 469),高于城镇组;模式2感染率为44.31％(1 537/3 469),低于城镇组(x2=21.38和14.17,P均＜0.01).高中(中专)及以下学历模式1的感染率为39.65％(1 589/4 008),高于大专及以上组(X2=21.81,P＜0.01);模式2和模式4感染率分别为44.74％(1 793/4008)和10.03％(402/4008),均低于大专及以上学历组(X2=16.08,P＜0.01;x2=6.46,P＜0.05).模式1和9感染孕产妇中,HBVDNA＞105 IU/mL者占比较高,分别达到84.84％(1 416/1 669)和89.25％(83/93);模式2和模式4感染的孕产妇HBV DNA＜500 IU/mL者占比高,分别达到81.25％(1 595/1 963)和76.48％(335/438).结论 云南省现阶段孕产妇感染HBV血清学组合模式以模式1、模式2为主,HBV DNA含量以＜500 IU/mL及＞105 IU/mL为主,年龄集中在15～34岁,以农村居民及低文化程度群体为主.     

杭州地区妊娠晚期孕妇病毒性肝炎感染的调查研究

目的:调查杭州市2958例妊娠晚期孕妇乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)、丁型肝炎病毒(HDV)、戊型肝炎病毒(HEV)的感染状况。方法:对杭州市2958例妊娠晚期孕妇的血清乙型肝炎标志物、HCV抗体、HDV抗体、HEV抗体的检测结果进行统计分析。结果:2958例妊娠晚期孕妇中乙型肝炎总感染率40.16%,HCV抗体阳性率0.40%,HDV抗体阳性率0.20%,HEV抗体阳性率2.60%。结论:杭州地区妊娠晚期孕妇病毒性肝炎的感染以乙型肝炎位居第一、戊型肝炎次之,丙型肝炎及丁型肝炎感染率较低。应加强育龄女性易感人群乙肝疫苗的预防接种,开展和实施有效的预防措施来防止病毒性肝炎的感染,提高新生人口的素质。     

Sexual transmission of hepatitis C virus infection

The role of sexual transmission in the diffusion of HCV infection, was studied through the seroprevalence of anti-HCV antibodies in the heterosexual habitual partners of 83 anti-HCV positive subjects. The index cases were represented by 10 dialysed subjects, 31 patients with chronic liver disease and 42 healthy carriers. Seroprevalence of anti-HCV positivity reported in partners was 8.43%, with a higher rate in cohabitants of patients with chronic liver disease (16.12% vs 4.76% of carriers); no case was found among partners of dialysed subjects. Laboratory and ultrasonograph signs of chronic hepatitis were reported in 3 cases (3.61%). Control on 70% of the cohabitants' relatives, was negative for HCV infections. These data suggest a possible sexual transmission of HCV infection, even if its prevalence resulted modest, undoubtedly lower than in other disease sexually transmitted.     

乙型肝炎病毒宫内感染的分子流行病学研究

目的为了掌握乙型肝炎病毒宫内感染的发生率和危险因素,探讨HBV相关抗体在胎儿体内产生的作用。方法用ELISA法筛选出HBsAg阳性孕妇及引产胎儿153例 ,HBsAg阴性孕妇及胎儿65例 ,共218例。然后用多聚酶链技术对孕妇 -引产胎儿HBV宫内感染进行检测。结果HBsAg阳性孕妇HBVDNA宫内感染率为53.59 %(82/153) ,HBsAg阴性孕妇静脉血中6.15%(4/65)检出HBVDNA阳性 ,两者相比有显著性差异 (P<0.01) ;母亲血中HBsAg、HBeAg、抗 -HBc同时阳性其相应胎儿HBVDNA感染率为92.5%(74/80) ,46例抗 -HBs阳性的胎儿血有5例检出HBVDNA阳性。结论HBV宫内感染率较高 ,HBsAg阴性孕妇也可能发生HBV宫内感染 ,应引起人们的重视     

浙江省温州地区妊娠妇女睡眠障碍流行病学调查

睡眠障碍可对人体多系统产生影响,也是妊娠妇女常见的症状[1].睡眠障碍是先兆子痫的危险因素,可以造成胎儿宫内生长受限、产程延长、剖腹产概率增加、早产,甚至使胎儿窒息、死亡[2].为了解我国妊娠妇女睡眠障碍发生情况及相关因素,对温州地区2000名孕妇睡眠状况进行问卷调查.     

The prevalence of hepatitis C virus antibodies among the voluntary blood donors of New Delhi,India

Infection with hepatitis C virus (HCV) is a major cause of transfusion-associated hepatitis, cirrhosis and hepatocellular carcinoma. The present study was conducted with an objective to evaluate the prevalence of anti-HCV antibody in New Delhi, India using a large number of healthy voluntary blood donors. A total of 15,898 healthy voluntary blood donors were subjected to anti-HCV testing (using a commercially available third generation anti-HCV ELISA kit) and 249 were found to be reactive for anti-HCV antibody, yielding an overall prevalence of 1.57%. No significant difference was found between the HCV positivity rate of male (1.57%; 238/15,152) vs. female (1.47%; 11/746) donors, family (1.58%; 213/13,521) vs. altruistic (1.51%; 36/2377) donors and first-time (1.55%; 180/11,605) vs. repeat (1.61%; 69/4293) donors. The age distribution of anti-HCV reactivity showed a maximum prevalence rate of 1.8% in the age group of 20–29 years. In addition, there was a clear trend of decreasing positivity for anti-HCV with increasing age and this trend was statistically significant. The results of the present study show that the prevalence of anti-HCV antibodies in the healthy voluntary blood donors of New Delhi, India is considerably higher than the reported seroprevalence of HCV in majority of the industrialized nations and this represents a large reservoir of infection capable of inflicting significant disease burden on the society. In addition, donors of New Delhi, India showed a trend of decreasing seroprevalence with increasing age, possibly implying a higher exposure rate to HCV in younger subjects.     

乙肝免疫球蛋白在乙肝感染孕妇产前阻断中的作用

目的 对合肥市乙肝感染孕妇母婴阻断结果进行分析,评价现行的产前阻断方式的有效性,为阻断乙肝病毒垂直传播提供依据。方法 利用已经建立的合肥市乙肝感染孕妇监测系统,按照乙肝感染孕妇乙型肝炎病毒-DNA（hepatitis B virus-DNA,HBV-DNA）滴度的风险区和产前是否注射乙肝免疫球蛋白分组,在婴儿一周岁时检测乙肝五项,乙肝表面抗原（hepatitis B surface antigen, HBsAg）阳性者为阻断失败。同时对注射乙肝免疫球蛋白（hepatitis B immune globulin,HBIg）的乙肝感染孕妇进行注射前和注射后HBV-DNA病毒滴度监测,以研究产前注射乙肝免疫球蛋白对乙肝病毒垂直传播的影响。结果 2009-2013年全市共监测乙肝感染孕妇395例,对照组的阳性率为2.74%,阻断组的阳性率为3.88%。χ²检验显示两组间阳性率差异无统计学意义。注射HBIg的乙肝感染孕妇注射前和注射后HBV-DNA病毒滴度变化差异无统计学意义。结论 乙肝感染孕妇产前注射乙肝免疫球蛋白的效果有待进一步研究。     

妊娠合并乙肝病毒感染的临床分析

目的 探讨妊娠合并乙肝病毒感染对妊娠生化指标及妊娠结局的影响.方法 回顾性对比分析642例妊娠合并乙肝病毒感染(乙肝组)和642例妊娠无乙肝病毒感染(aY-常妊娠组)的常规生化指标及妊娠结局.结果 (1)乙肝组TP,ALB显著低于正常妊娠组;TB,DB,ALT,AST,GGT,TBA,GCT显著高于正常妊娠组:ALP与正常妊娠组无差别. (2)妊娠合并乙肝病毒感染和正常妊娠母体的并发症分别为:IGT 10.8％,6.2％:GDM 10.3％,4.8％;PIH 5.3％,1.1％;产后出血11.5％,4.0％;蛋白尿17.9％,7.5％;尿WBC阳性25.5％.7-8％;尿RBC阳性21.8,6.9％;血清总胆红素升高5.8％,0.6％;肝酶升高21.8％,2.8％. (3)妊娠合并乙肝病毒感染和正常妊娠新生儿并发症的发生率分别为:早产9.7％,2.7％;黄疸32.1％,8.3％;肺炎5.6％,1.9％:小样儿3.6％,1.2％;窒息4.1％,1.2％.结论 妊娠合并乙肝病毒感染妊娠母体和新生儿各类并发症的发生率明显高于正常妊娠孕妇,临床应加强对妊娠合并乙肝病毒感染的母婴监测,减少并发症的发生,提高母婴健康.     

Hepatitis C virus, hepatitis B virus and human immunodeficiency virus infection in pregnant women in North-East Italy: A seroepidemiological study

Background: Pregnant women can be considered a sentinel population, because they are a relatively unselected population whose prevalence data may be extended to the general population. Methods: A seroepidemiological study was carried out in Padua (North-East Italy) to assess the epidemiological aspects of HCV, HBV and HIV infection in 2059 pregnant women consecutively seen at the Department of Obstetrics and Gynaecology during 1996. Out of them, 1804 (87.2%) were indigenous and 255 (12.8%) immigrants. Sociodemographical and sanitary data were collected for each woman. Results: The overall prevalence of anti-HCV was 1.9% (42.5% with detectable HCV-RNA); HBsAg was found in 1.0%; the prevalence of anti-HIV was 0.3%. Findings are substantially consistent with the epidemiological picture of such infections in the general population of our geographic area. A parenteral risk factor for HCV infection was found in 19 subjects (47.5%): 18 were intravenous drug users and 1 a blood transfusion recipient. HBsAg seroprevalence was higher in immigrants than in autochthonous (3.1% vs. 0.7% respectively, p < 0.01). One of the 6 anti-HIV positive women was intravenous drug user. Logistic regression analysis was carried out for each viral agent to determine which characteristics were independently associated with infection: anti-HCV prevalence resulted independently associated to Italian origin (OR: 3.7), unmarried status (OR: 2.7), unemployed condition (OR: 6.1) and history of previous abortion (OR: 2.8). HBsAg prevalence was independently associated to unemployed condition (OR: 10.8), whereas HIV positivity was significantly related to the unmarried status (OR: 18.5). Conclusion: Our study pinpoints the need of screening all pregnant women for HCV and HIV infection, in addition to the HBsAg screening which is compulsory in Italy.     

乙型肝炎免疫球蛋白阻断HBV垂直传播的疗效观察

目的 观察评价外源性注射乙型肝炎免疫球蛋白(HBIG)对HBV母婴垂直传播的阻断效果和安全性.方法 选取2006年7月-2007年7月在我院产前检查和分娩的HBsAg阳性孕妇200例作为研究对象,根据知情同意原则,分为3组.A组:同意孕期及产后注射HBIG者75例;B组:同意产后注射HBIG者85例;C组:不同意或因经济原因无法注射HBIG者40例.凡新生儿HBV DNA阳性,即表示胎儿宫内感染HBV;婴儿出生后6个月HBV DNA阳性,亦表示垂直传播HBV.结果 孕28周时孕妇HBV标志物各指标检测结果3组间比较,差异无统计学意义(P>0.05),而A组经过产前3次HBIG注射之后,HBsAg、HBeAg、抗-HBs阳性率与B组和C组间比较,差异有统计学意义(P<0.01,P<0.05).3组孕妇在孕28周和产前血清中的HBV DNA阳性率间比较,差异无统计学意义(P>0.05);3组产后乳汁中HBV DNA阳性率间比较,差异有统计学意义(P<0.05,P<0.01).新生儿和6个月婴儿HBV感染率A组相似文献   

深圳市2011-2014年孕妇乙型肝炎病毒感染状况分析

目的 了解2011-2014年深圳市孕妇乙型肝炎病毒（hepatitis B virus,HBV）感染状况,为预防和控制乙型肝炎（简称乙肝）母婴传播提供科学依据。方法 对到助产机构初次进行产前检查的孕妇免费检测乙肝两对半,并由助产机构责任医生将孕妇的基本信息及检测结果录入自主研发的信息管理系统,通过SPSS 19.0进行统计分析。结果 深圳市孕妇乙肝表面抗原（hepatitis B surface antigen,HBsAg）阳性率、乙肝表面抗体（antibody to hepatitis B surface antigen,抗-HBs）阳性率、乙肝病毒e抗原（hepatitis B e antigen,HBeAg）阳性率、乙肝病毒e抗体（antibody to hepatitis B e antigen,抗-HBe）阳性率及乙肝病毒c抗体（antibody to hepatitis B core antigen,抗-HBc）阳性率分别为8.40%、47.84%、3.11%、12.28%、21.24%。不同年份、户籍类型、年龄、文化程度和职业的孕妇HBsAg、抗-HBs、HBeAg、抗-HBe和抗-HBc这五项指标阳性率之间的差异均有统计学意义（均有P<0.001）。结论 深圳市孕妇HBsAg阳性率仍高于全国水平,半数以上孕妇没有检测到抗-HBs,流动人口孕妇HBV感染状况较常住人口严重。加强深圳市孕妇的免疫接种和查漏补种,有助于控制乙肝母婴传播。     

珠海市妊娠期妇女合并梅毒、艾滋病、乙肝、丙肝感染情况的趋势分析

目的探讨珠海地区孕妇的梅毒、艾滋病、乙肝、丙肝四种传染性疾病的感染情况。方法用统计学方法分析珠海市在笔者所在医院做产前检查和分娩的10242例孕妇梅毒、艾滋病、乙肝、丙肝的血清标志物检测结果。结果珠海市孕妇的乙肝、丙肝感染率逐年下降;梅毒感染率逐年上升;2008年的一个住院产妇检测出抗-HIV阳性。结论珠海市孕妇的乙肝感染率逐年下降,但相互间差异无统计学意义（P〉0．05）;丙肝感染率逐年下降,年度相比有显著差异（P〈0．05）;梅毒感染率逐年上升,由2006年的0．32％上升到2008年的0．61％,年度比较有显著差异（P〈0．05）;2008年的一个住院产妇检测出抗-HIV阳性。     

单采浆还输血球献血员中丙型肝炎病毒感染的流行病学和血清学研究

本文报告单采浆献血员中丙型肝炎病毒(HCV)感染的流行病学和血清学研究结果。通过对5个自然村3 496人流行病学调查表明,单采浆献血员肝炎现患率和单项ALT异常率分别为17.10%和23.23%,二者均显著高于全血献血员和非献血员成人。经排除法证明,上述肝炎患者绝大多数为肠道外传播的非甲非乙型肝炎。后将部分单采浆献血员肝炎病例和单项ALT异常者的血清标本,送美国疾病控制中心检测,抗-HCV阳性率分别为97.06%和100%。证实为HCV感染。流行病学调查表明,单采浆献血员HC流行是由单采浆还输血球过程中交叉感染引起的。     

乙型肝炎病毒母婴传播阻断研究进展

HBV母婴传播是HBV传播的重要途径,而宫内传播又是母婴传播的主要途径,其危害大、治疗难,因此做好母婴传播的阻断,尤其宫内传播阻断,对控制HBV传播意义重大。此文就HBV母婴传播的阻断方法及疗效研究进展进行综述。