乙型肝炎病毒宫内感染相关因素的研究

目的探讨乙型肝炎病毒（HBV）宫内感染的相关因素、新生儿外周血单个核细胞（PBMC）及胎盘HBV感染的影响因素。方法分别采用酶联免疫吸附试验,检测151例血清HBsAg阳性孕妇HBV标志物及其新生儿血清HBsAg;PCR检测孕妇及其新生儿血清和PBMC中的HBV DNA;免疫组化ABC法检测孕妇胎盘组织中HBsAg。非条件logistic回归模型对孕妇血清HBV DNA阳性、孕妇PBMC HBV DNA阳性、胎盘HBV感染等73项危险因素进行分析。结果（1）151例血清HBsAg阳性孕妇分娩的151例新生儿中,血清HBsAg阳性5例,血清HBV DNA阳性29例,PBMC HBV DNA阳性36例,HBV标志物任一项阳性57例,宫内感染率为37．8％（57／151）。（2）HBV宫内感染的危险因素为孕妇血清HBV DNA阳性、孕妇PBMC HBV DNA阳性、胎盘HBV感染比值比（OR）分别为2．25（1．08～4．72）、2．69（1．26～5．73）、4．63（1．70～12．62）。（3）胎盘HBV感染的危险因素为孕妇血清HBV DNA阳性,OR为4．24（1．22—14．69）。（4）新生儿PBMC HBV DNA阳性的危险因素为孕妇PBMC HBV DNA阳性,OR为24．53（7．92～76．01）。结论孕妇PBMC和血清HBV DNA阳性及胎盘HBV感染为HBV官内感染的危险因素;孕妇PBMC HBV DNA阳性可能是形成新生儿宫内感染的独立危险因素。

Study on hepatitis B virus intrauterine infection state and its correlation factors

Objective To investigate the correlation factors of hepatitis B virus (HBV) intrauterine infection and the influence factors of HBV infection in peripheral blood mononuclear cells ( PBMC) and placentas. Methods HBeAg and HBsAg in 151 pregnant women and their newborns were determined by enzyme linked immunoadsorbent assay (ELISA). HBV DNA in serum and PBMC of pregnant women and their newborns were determined by polymerase chain reaction. HBsAg in 151 placentas were detected by immunohistochemistry ABC. The correlation risk factors were analyzed by non-condition logistic regression model. Results HBV DNA positive in serum, HBV DNA positive in PBMC of pregnant women and HBsAg positive in placentas were the risk factors for HBV intrauterine infection. Their odds ratio(OR) and 95% confidence interval were 2.25 (1.08-4.72),2.69 (1.26-5.73) and 4.63 (1.70-12.62),respectively. The influence factors of HBV infection in placenta included antepartum injection of hepatitis B immunoglobulin (HBIG) over thrice and HBV DNA positive in serum of pregnant women with OR 0.08 (0.01-0.69) and 4.24(1.22-14.69). The risk factor for HBV DNA positive in PBMC of newborns was HBV DNA positive in PBMC of their mothers with OR 24.53 (7.92-76.01). Conclusions HBV infection in placentas, HBV DNA positive in PBMC and serum of pregnant women are the risk factors for HBV intrauterine infection. Antepartum injection of HBIG over thrice can protect placentas from being infected by HBV to some extent. PBMC HBV DNA positive in pregnant women is probably the independent risk factor for PBMC HBV intrauterine infection in newborns.