乙型肝炎病毒感染胎盘的免疫组织病理学研究

目的：分析胎儿乙型肝炎病毒（HBV）感染与胎盘感染的关系。探讨HBV通过胎盘屏障感染胎儿的机理,方法：采用聚合酶链反应及酶联免疫吸附试验,对61例HBV携带孕妇的新生儿脐血或静脉血行HBV DNA及HBsAg检测,证实有胎儿HBV感染的28例为胎儿感染组,无胎儿HBV感染的33例为对照组,对两组孕妇的胎盘行免疫组织病理学检查并作组织学分级,结果：（1）61例HBV携带孕妇的胎盘组织中,共发现HBsAg和（或）HBcAg阳性41例,阳性率为67％,其中胎儿感染组阳性23例,阳性率为83％,对照组阳性18例,阳性率为55％,两组比较,差异有显著性（P＜0．05）,（2）两组胎盘组织细胞成分比较显示,胎儿感染组羊膜细胞的HBsAg和（或）HBcAg阳性率为36％（10／28）,明显高于对照组的6％,两组比较,差异有极显著性（P＜0．01）,（3）在两组的胎盘屏障各层组织细胞中,合体细胞的HBsAg和（或）HBcAg阳性率（49％）最高,明显高于其他层次组织细胞的阳性率（P＜0．05）,（4）两组胎盘组织病理学比较显示,胎儿感染组纤维样坏死（＋＋＋）发生率为29％,绒毛血管增生或充血的发生率为50％,均分别高于对照组的9％,15％,而胎儿感染组Hofbauer细胞阳性率为46％,明显低于对照组的79％,两组比较,差异有显著性（P＜0．05）,结论：胎儿感染HBV与胎盘感染有关,胎盘组织中可出现纤维素样坏死及绒毛血管增生或充血增多,Hofbauer细胞减少等改变,羊膜细胞感染是胎儿宫内HBV感染的重要因素之一,胎盘屏障对胎儿有一定的保护作用。

Relationship between the immunohistopathological changes of hepatitis B virus carrier mothers' placentas and fetal hepatitis B virus infection

Objective To investigate the role of placenta in intrauterine transmission of hepatitis B virus (HBV), and the relationship between the fetal HBV infection and the placental infection Methods Cord blood or peripheral blood was obtained from 61 newborn infants of HBsAg positive mothers Neonates (28 of 61) infected by HBV were assigned to fetal infected group, and 33 infants without infection were assigned to control group Histopathological changes of placentas from 61 HBsAg positive mothers were observed by pathological examination and classification Results (1) The positive rate of HBsAg/HBcAg detected in the placentas of fetal infected group was 82% (23/28), which was significant higher than that of control group (55%), P <0 05 (2) Among various types of cells in placental tissue, the amnionic cell showed higher HBsAg/HBcAg positive rate in fetal infection group, which was 36% (10/28), than that of control group (6%) ( P <0 01) (3) The syncitial cell was the cell with the higher detecting HBsAg/HBcAg positive rate (49%) comparing with other types of cells in placental barrier ( P <0 05) (4) The incidence of fibrinoid necrosis and chorionic hyperemia in fetal infection group were 29% and 50%, respectively, which were higher than those in control group (9%, 15%) The detecting rate of Hofbauer cell in fetal infection group was 46%, significantly lower than that in control group (79%) ( P <0 05) Conclusions HBV infection of fetus is associated with placental infection HBV infection of amnionic cell is an important factor of intrauterine infection Placental barrier can protect the fetuses from infection to some extent Some histopathological changes of placental tissue, for example fibrinoid necrosis, chorionic hyperemia and decreasing number of Hofbauer cells , may play a role in fetal HBV infection