HBsAg阳性孕妇IL-4的表达在HBV宫内传播中的作用

目的 探讨HBsAg阳性孕妇外周血IL-4水平在乙型肝炎病毒（HBV）宫内传播中的表达变化。方法 以陕西省西北妇女儿童医院住院分娩的306例HBsAg阳性孕妇为病例组,74例健康孕妇为对照组进行流行病学调查,采用ELISA法检测孕妇和新生儿外周血乙型肝炎5项指标,采用实时荧光定量PCR检测HBV DNA水平,采用流式液相芯片法检测细胞因子IL-4水平。结果 HBsAg阳性孕妇发生HBV宫内显性感染（DBI）、HBV宫内隐匿性感染（OBI）和HBV宫内传播(BIT)率为11.44%（35/306）、36.60%（112/306）、48.04%（147/306）。对照孕妇IL-4水平低于HBsAg阳性孕妇组、HBV宫内未传播组(NBIT)、显性感染组（DBI）和隐匿性感染组（OBI）,差异均有统计学意义（均有P<0.01）;HBeAg阴性组中DBI组的IL-4水平高于OBI组和HBIT组,差异有统计学意义（P<0.05）; 随着母血中HBV DNA载量的增高,DBI组IL-4水平呈下降趋势（P<0.05）,在HBV DNA载量小于10³ IU/mL时,DBI组IL-4水平高于OBI组（P<0.05）和NBIT组（P<0.01）,并且随着BIT程度的加重,母血中IL-4水平呈增高趋势（P<0.05）;多因素分析显示：孕妇HBeAg和HBV DNA 载量与其IL-4水平呈正相关;孕妇HBeAb与其IL-4水平呈负相关。结论 HBsAg阳性孕妇细胞免疫功能紊乱导致 IL-4水平升高,开展HBsAg阳性孕妇外周血IL-4监测对其新生儿是否发生HBV宫内传播可能具有一定预测作用。

Role of IL-4 expression in HBsAg positive pregnant women in intrauterine transmission of HBV

Objective To investigate the expression of IL-4 in peripheral blood of HBsAg positive parturients in intrauterine transmission of hepatitis B virus (BIT). Methods Epidemiological investigation was carried out on 306 HBsAg positive parturients delivered in Northwest Women and Children's Hospital of Shaanxi Province and 74 health parturientsas control group. Enzyme-linked immunosorbent assay (ELISA) was used to detect five makers of hepatitis B, real time PCR was used to detect HBV-DNA, and flow liquid chip method was used to detect IL-4 in peripheral blood of pregnant women and newborns. Results The incidence of dominant HBV infection(DBI), occult HBV infection(OBI) and BIT were 11.44%(35/306),36.60%(112/306) and 48.04%(147/306), respectively. The levels of IL-4 in peripheral blood of HBsAg-negative parturients were significantly lower than those of HBsAg-positive parturients, NBIT group, DBI group, and OBI group (P<0.01).The level of IL-4 in HBeAg negative group of DBI group was significantly higher than that in OBI group (P<0.05) and HBIT group (P<0.05). With the increase of HBV DNA load in maternal blood, the level of IL-4 in DBI group descended (P<0.05). When HBV DNA load was smaller than 10³ IU/mL, the level of IL-4 in DBI group was significantly higher than OBI group (P<0.05) and NBIT group (P<0.01), and descended with the increase of BIT. The level of maternal IL-4 had positive relation to the maternal HBeAg status and HBV DNA load in maternal blood. The level of maternal IL-4 had negative relation to the maternal HBeAb status in maternal blood. Conclusions There is imbalance of Th1/Th2 cells in pregnant women, which causes the activity of IL-4 increases. Monitoring the level of IL-4 in HBsAg-positive pregnant women can predict the probability of HBV intrauterinetransmission.