阻断乙型肝炎病毒母婴传播对血清病毒转录体的影响

The effect on sero-viral transcript by inhibiting transmission of hepatitis B virus from mother to infant

目的进一步探讨阻断乙型肝炎病毒(HBV)母婴垂直传播的效果,明确携带HBV孕妇干预治疗对保护婴儿抗-HBV感染的意义。探讨乙型肝炎病毒转录体(RNA)检测在母婴传播诊断中的意义。方法将91例 HBsAg／HBeAg呈阳性孕妇分成两组。其中治疗组为61例,以乙肝免疫球蛋白(HBIG)与左旋咪唑涂布剂阻断治疗;对照组为30例。治疗组在孕26周起开始阻断治疗,自母亲及其婴儿血清和母亲乳汁中提取核酸,经PCR及RT-PCR分别扩增HBV DNA和RNA,Southern-blotting验证反应的特异性,取代表性产物克隆、测序,检测血清HBV DNA及全长型(fRNA)和顿挫性转录体(trRNA)。结果治疗组和对照组新生儿外周血HBV DNA、fRNA和trRNA的阳性率分别为3．3%,3．3%,47．5%和6．7%, 13．3%,70．0%。治疗组的前二项指标明显低于对照组,差异有显著意义(P<0．01),但trRNA差异无显著意义(P>0．05)。结论携带HBV孕妇于孕晚期给予HBIG和左旋咪唑涂布剂阻断治疗后,婴儿HBV DNA和fRNA携带率明显降低。治疗组和对照组均有超过1/2的患儿携带trRNA。trRNA在HBV母婴垂直传播过程中有可能是一个出现更早期的可检测指标,有助于确定新生儿HBV感染的状态。

Objective To further investigate the preventive effects on different intervention approaches on mother-infant vertical transmission of hepatitis B virus （HBV）. To investigate the characteristics and clinical significance of HBV transcripts （RNA） in transmitting from mother to infant. Methods 91 cases chronic HBsAg/HBeAg-carriers in pregnancy were divided into two groups. 61 cases received anti-HBV immunoglobulin injections and levamisole liniment since the 26th week of gestation;30 control cases did not receive the treatment. The viral DNA and different types of transcripts in the sera were detected using PCR and RT-PCR, respectively. Representative amplification products were cloned and sequenced. The serum viral nucleic acids extracted from pairs of mother and infant were analyzed using PCR and RT PCR targeted to the HBV protein encoding region. Reaction specificity was confirmed by Southern blotting. Results The seropositivity rates for HBsAg, viral DNA and full length and trucated transcripts in babies from the treatment and reference groups were3. 3%, 3. 3%, 47. 5% and 6.7%, 13. 3%, 70. 0%, with the first three parameters, rather than the last one, being significantly reduced in the former group than those in the latter. Conclusion The intervention therapy with immunoglobulin injections and levamisole liniment during pregnancy seems preventive on the vertical transmission of HBsAg, HBV DNA and full length transcripts, rather than that of the truncated viral RNA moleicues obviously reduced transcripts. Compared with HBV DNA and HBV gene expressing products, trRNA might be a earlier detectable serum maker for identifying HBV infection profile accurately in infnats ,which was associated closely with. their mothers＇ expression of trRNA.