外周血单个核细胞在乙型肝炎病毒母婴传播中的作用研究

The role of peripheral mononuclear cells in matemoinfant transmission of hepatitis B virus

目的 探讨外周血单个核细胞(PBMC)在乙型肝炎病毒(HBV)母婴传播中的作用及在早期诊断宫内感染的价值。方法 120例经ELISA法确定为乙型肝炎表面抗原(HBsAg)阳性的孕妇为研究组,其中60例为HBsAg和乙型肝炎e抗原(HBeAg)双阳性,定为双阳组;60例仅为HBsAg阳性,定为单阳组。30例非HBV携带的孕妇为对照组。应用PCR法检测母婴血清及PBMC中HBV-DNA。结果 双阳组中,血清HBV-DNA检出率为25.0％(15/60),脐血PBMC中HBV-DNA检出率为50.0％(30/60)。母婴PBMC的HBV-DNA阳性显著相关(P<0.05);脐血血清HBV-DNA检出率与脐血PBMC中HBV-DNA检出率两者比较,具有显著性差异(P<0.001);母婴血清HBV-DNA阳性无相关性(P>0.05)。结论 被HBV感染的PBMC可通过胎盘感染胎儿,可能是HBV宫内传播的一种机制,脐血PBMC HBV-DNA阳性率明显高于脐血清,对早期诊断HBV宫内感染有一定价值;母亲传染性强是宫内感染的重要因素。

Objective To investigate the significance of peripheral blood mononuclear cells (PBMC) in maternoinfant transmission of hepatitis B virus (HBV) and the value of early diagnosis in HBV intrauterine infection. Methods 120 pregnant women with HBsAg positive were used as study group including 60 cases with HBsAg ( + ) and HBeAg ( + ) in double positive group and 60 HBsAg ( + ) and HBeAg ( - ) in single positive group. 30 HBsAg negative cases were in the control group. HBV-DNA in serum and PBMC were measured respectively by PCR. Results In double positive group, HBV-DNA was found in 25% (15/60) of serum samples and 50% (30/60) of PBMC of umbilical blood. HBV-DNA in PBMC of umbilical blood was relevant to that of pregnant women. HBV-DNA positive was significantly differente ( P < 0.01) between umbilical sera and umbilical PBMC. HBV-DNA in serum of pregnant women was not related to that of umbilical blood (P > 0.05) . Conclusions PBMC infected by HBV may infect fetus through placenta. Detecting HBV-DNA in umbilical PBMC is helpful for early diagnosis of HBV intrauterine infection. Strong infectiousness of mother is an important factor in intrauterine infection.