乙肝病毒携带者实施体外授精处理的垂直传播风险

目的:探讨乙肝病毒携带者实施体外授精过程HBV DNA的变化,评价体外操作的安全性。方法:应用荧光定量聚合酶联反应(FQ-PCR)技术检测乙肝病毒携带者血清、卵泡液、精子上游液、IVF受精培养液中HBV DNA含量。结果:24对夫妇中妻子乙肝大三阳血清HBV DNA阳性率100%,卵泡液HBV DNA阳性率83.3%,IVF受精培养液HBV DNA阳性率54.16%。12对夫妇中丈夫乙肝大三阳血清HBV DNA阳性率75%,精子上游液HBV DNA阳性率25%,IVF受精培养液HBV DNA阳性率16.67%。1对夫妇双方均乙肝大三阳血清HBV DNA阳性率100%,卵泡液、精子上游液和IVF受精培养液HBV DNA阴性。16对夫妇中妻子乙肝小三阳,17对夫妇中丈夫乙肝小三阳,3对夫妇双方乙肝小三阳的血清、卵泡液、精子上游液、IVF受精培养液HBV DNA阴性。IVF-ET临床妊娠率乙肝大三阳组37.84%,乙肝小三阳组36.11%,差异无统计学意义(P=0.948)。结论:乙肝大三阳患者血清、卵泡液、精子上游液和IVF培养液中HBV DNA阳性率高,临床和实验室操作应重视交叉感染问题,但IVF培养环境乙肝病毒检出率逐渐降低,提示体外培养没有增加病毒垂直传播风险,血清乙肝病毒复制水平高低对IVF-ET临床妊娠率无显著影响。

Vertical transmission risk in the patients with hepatitis B virus in vitro fertilization

Objective:To investigate the HBV DNA contents changes in the patients with hepatitis B virus in IVF-ET therapy and evaluate operation safety out of body.Methods:The HBV DNA contents in serum,in follicular fluid,in sperm washing medium,in IVF culture medium with HBV were examined by fluorescence quantitative polymerase chain reaction(FQ-PCR).Result:By FQ-PCR,HBV DNA were examined out in serum of all of 24 wives with HBsAg positive and HBeAg positive,in follicular fluid of 83.3% of them,in IVF culture medium of 54.16% of them.HBV DNA were examined out in serum of 75% of 12 husbands with HBsAg positive and HBeAg positive,in sperm washing medium of 25% of them,in IVF culture medium of 16.67% of them.HBV DNA was examined out in serum of a couple with HBsAg positive and HBeAg positive,but HBV DNA were not examined out in follicular fluid in sperm washing medium and in IVF culture medium.HBV DNA were not examined out in serum,in follicular fluid,in sperm washing medium and in IVF culture medium of 16 wives with HBsAg positive,of 17 husbands with HBsAg positive and of 3 couples with HBsAg positive.Pregnancy rate in group with HBsAg positive was 37.14% and that in group with HBsAg positive and HBeAg positive was 36.36%,which was not significant(P=0.98).Conclusion:The rate of being examined out HBV DNA in these patients with HBsAg positive and HBeAg positive are high in serum,in follicular fluid,in sperm washing medium and in IVF culture medium.So cross contamination should be paid attention in operations in clinics and labs.The rate of being examined out HBV DNA declined in outer culture circumstance.Vertical transmission risk is not increased in operations out of body in IVF-ET therapy.Pregnancy rate is not affected by patient HBV contents in IVF-ET therapy.