乙型肝炎病毒载量、标志物、基因型和耐药位点检测在母婴传播阻断术中的临床价值

Clinical value of load,markers,genotype,and drug-resistant site detection of Hepatitis B virus to block mother-to-child transmission

目的探讨乙型肝炎病毒DNA(Hepatitis B virus DNA,HBV-DNA)、乙型肝炎病毒基因型(Hepatitis B virus genotype,HBV-GT)、乙型肝炎病毒e抗原(Hepatitis B virus e antigen,HBeAg)、乙型肝炎病毒耐药位点(HBV-resistance mutation sites,HBV-RMS)检测在母婴传播阻断中的价值。方法收集十堰市人民医院(湖北医药学院附属人民医院)2015年1月-2018年2月718例妊娠期和备孕期HBV携带者、慢性乙型肝炎(Chronic hepatitis B,CHB)、肝功能衰竭患者,计划实施母婴传播阻断者。检测HBV-DNA、HBeAg、HBV-GT、HBV-RMS、肝功能、凝血功能。将全部病例分为HBV-GT B组、HBV-GT C组,统计两组高HBV-DNA(HBV-DNA≥1+E005 IU/ml)患者数、HBV-RMS患者数、HBeAg阳性患者数、CHB患者数、慢加急性肝功能衰竭(Acute chronic liver failure,ACLF)患者数。结果(1)HBV-GT:HBV-GT B 490例(68.25%),HBV-GT C 212例(29.53%),HBV-GT D 4例(0.56%),HBV-GT B+C 8例(1.11%),HBV-GT C+D 4例(0.55%)。(2)HBV-RMS:检出6例HBV-RMS患者(0.84%),妊娠早期、妊娠中期、妊娠晚期各2例;ACLF 1例,CHB 5例;HBV-GT B患者1例、HBV-GT C患者5例(χ2=5.8874,P=0.0153)。(3)HBV-DNA和HBeAg:HBV-GT B高病毒载量288例(58.77%)、HBV-GT C高病毒载量149例(70.28%),差异有统计学意义(χ2=9.2227,P=0.0024)。HBV-GT B患者HBeAg阳性308例(62.86%);HBV-GT C患者HBeAg阳性155例(73.11%),差异有统计学意义(χ2=7.8298,P=0.0051)。(4)CHB患者:CHB患者127例(17.89%);HBV-GT B患者68例(13.65%)、HBV-GT C患者59例(27.83%),差异有统计学意义(χ2=19.3901,P=0.0091);经抗病毒、护肝治疗恢复正常。结论高HBV-DNA、HBeAg阳性是母婴传播危险因素,HBV-GT C是病毒耐药的危险因素。在HBV-DNA、HBeAg、HBV-GT、HBV-RMS检测指导下,可提高HBV母婴传播阻断技术成功率和安全性。

Objective To explore the clinical value of detections of Hepatitis B virus DNA(HBV-DNA)level,Hepatitis B virus genotype(HBV-GT),Hepatitis B virus e antigen(HBe Ag)and drug-resistant site of Hepatitis B virus to block mother-to-child transmissions.Methods Totally 718 patients carried with HBV during gestation and pregnancy,Chronic hepatitis B(CHB)and liver failure who planned to implement blocking the mother to child transmission were selected to block mother-to-child transmission.HBV-DNA,HBe Ag,HBV-GT,HBV-RMS,liver function and blood coagulation function of patients were tested.All the patients weredivided into HBV-GT B Group and HBV-GT C Group,and the case loads of patients with high HBV-DNA level(HBV-DNA≥1+E005 IU/ml),patients with HBV-RMS,patients with positive HBeAg,patients with CHB and patients with acute chronic liver failure(ACLF)were counted respectively.Results(1)There were 490patients with HBV-GT:HBV-GT B(68.25%),212 patients with HBV-GT C(29.53%),4 patients with HBV-GT D(0.56%),8 patients with HBV-GT B+C(1.11%),4 patients with HBV-GT C+D(0.55%).(2)There were 6 patients with HBV-RMS(0.84%)were detected,including 2 patients with first trimester of pregnancy,second trimester of pregnancy and late trimester pregnancy respectively;there were 1 patient with ACLF,5 patients with CHB,5 patients with HBV-GT B and 5patients with HBV-GT C(χ~2=5.8874,P=0.0153).(3)For HBV-DNA and HBe Ag:There were 288 patients(58.77%)with high viral load of HBV-GT B,149 patients(70.28%)with high viral load of HBV-GT C,and the difference was statistically significant(χ~2=9.2227,P=0.0024).There were 308 patients(62.86%)with positive HBe Ag,155 HBV-GT C patients(73.11%)with positive HBe Ag,and the difference was statistically significant(χ~2=7.8298,P=0.0051).(4)For CHB patients,there were 172 patients(17.89%)with CHB;68 patients(13.65%)with HBV-GT B,and 59 patients(27.83%)with HBV-GT C;the difference was statistically significant(χ~2=19.3901,P=0.0091);and such patients recovered to be normal after antiviral and liver protection treatment.Conclusion High HBV-DNA level and positive HBe Ag are risk factors for mother-to-child transmission,and HBV-GT C is a risk factor of viral resistance.The success rate and safety of blocking HBV mother-to-child transmission can be improved under the guidance for HBV-DNA,HBe Ag,HBV-GT and HBV-RMS tests.