母源外周血中IL-6表达水平与乙型肝炎病毒宫内传播的关系

目的探讨HBsAg阳性产妇外周血IL-6水平在乙型肝炎病毒(hepatitis B virus,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314例HBsAg阳性产妇为病例组,74例健康产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-6水平。结果 HBsAg阳性产妇发生宫内显性感染(dominant HBV infection,DBI)、宫内隐匿性感染(occult hepatitis B virus infection,OBI)和宫内传播(intrauterine transmission,BIT)率为10.83%(34/314)、38.22%(120/314)、49.04%(154/314)。对照组产妇IL-6水平低于HBsAg阳性产妇组(P<0.001)、NBIT组(P<0.001)、DBI组(P=0.006)和OBI组(P<0.001);未抗病毒治疗组中DBI组IL-6水平低于OBI组(P=0.008);未乙肝疫苗注射组中DBI组IL-6水平低于OBI组(P=0.012);产妇HBeAg和HBV DNA载量与其IL-6水平呈正相关(均有P<0.05);产妇HBeAb与IL-6水平呈负相关(P=0.011)。结论 HBV可以激发孕产妇体内IL-6的表达,但是IL-6在HBsAg阳性产妇体内的表达呈现组内分化现象,在HBeAg阳性和高载量HBV DNA环境下其IL-6的水平会上升,但当其水平下降时易发生DBI。

Relationship study between the IL-6 expression in maternal peripheral blood and intrauterine transmission of HBV

  Objective   To investigate the expression of IL-6 in peripheral blood of HBsAg positive parturients in HBV intrauterine transmission.   Methods   Epidemiological investigation was carried out on 314 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-6 in peripheral blood of pregnant women and newborns.   Results   The incidence of dominant HBV infection(DBI), occult HBV infection(OBI) and BIT were 10.83%(34/314), 38.22%(120/314), 49.04%(154/314), respectively. The levels of IL-6 in peripheral blood of HBsAg-negative parturients were significantly lower than those of HBsAg-positive parturients(P < 0.001), NBIT group(P < 0.001), DBI group(P=0.006), OBI group(P < 0.001). In the antiviral treatment group, the level of IL-6 in DBI group was significantly lower than OBI group(P=0.008).In non-hepatitis B vaccine group, the level of IL-6 in DBI group was significantly lower than OBI group(P=0.012). The level of maternal IL-6 have positive relation to the maternal HBeAg status and HBV DNA load in maternal blood(all P < 0.05).The level of maternal IL-6 have negative relation to the maternal HBeAb status in maternal blood(P=0.011).   Conclusions   HBV can stimulate the expression of IL-6 in pregnant and lying-in women, but the expression of IL-6 in HBsAg-positive parturients shows intra-group differentiation. The level of IL-6 in maternal will increase in HBeAg-positive and HBV DNA high-load environment. DBI is prone to occur when IL-6 level decreases.