HBV宫内感染机制的研究

目的：研究HBV宫内感染机理。方法：应用PCR技术检测59例HBsAg( )孕妇血清、阴道分泌物、羊水、胎盘及新生儿脐血清中HBV DNA。采用免疫组化ABC染色法检测胎盘中HBsAg及HBeAg。结果：新生儿宫内感染率为45．8％(27／59)；胎盘、羊水、阴道分泌物HBV DNA( )者宫内感染率分别为78．8％(26／33)、78．6％(22／28)、80．6％(25／31)均显著高于其HBVDNA(-)者。免疫组化ABC染色法检测胎盘中HBsAg、HBcAg。HBsAg及HBeAg在胎盘中分布由蜕膜细胞、滋养层细胞、绒毛间质细胞至胎儿面绒毛毛细血管内皮细胞依次递减，有胎盘中HBsAg及HBeAg分布于上述方向相反。当羊水、阴道分泌物HBV DNA( )时羊膜上皮细胞中检出HBsAg及HBcAg。结论：HBV经母血和(或)细胞直接蔓延方式进入胎儿血循环感染胎儿；可能存在阴道上行感染。

A study of mechanism of intrauterine transmission of hepatitis B virus

Objective To study the mechanism of intrauterine infection of Hepatitis B Virus (HBV). Methods HBV DNA in serum, amniotic fluid, secretion of vagina and placenta of 59 mothers with HBsAg and HBcAg in placenta were detected by PCR. HBsAg and HBcAg in placenta were detected by immunohistochemical chiomoscopy. Results Intrauterine infection rate of placenta, amniotic flaid and secretion of vagina HBV DNA (+) (78.8%, 78.6%, 80.6%) were significantly higher than that of HBV DNA(-). The positive rate of placenta HBsAg and HBcAg was 81.4%, 61.6%. HBsAg and HBcAg in placenta decreased gradually from maternal deciduas cell, chorionis epithelion, and chorionic interstitial cell to capillary endothelium of chorion. HBsAg and HBcAg was detected amniotic epithelium in part of placenta. It placenta increased gradually from deciduas cell to capillary endothelium in placenta. HBsAg and HBcAg were detected in amniotic epithelium. HBV DNA was detected in amniotic fluid and secretion of vagina. Conclusions Intrauterine transmission may be through mother's blood and/or cell spreading directly and virginal separately ascending infection.