乙肝病毒标志物在胎儿和胎盘组织中的表达及其与HBV母婴传播关系的研究

RELATIONSHIP BETWEEN THE EXPRESSION OF HBV MARKERS IN FETUS AND PLACENTA AND THE TRANSMISSION OF HBV FROM MOTHER TO INFANT

目的通过对乙肝阳性产妇外周血、胎儿及胎儿附属物进行乙肝病毒标志物的检测,探讨HBV宫内感染发生的机制。方法通过ELISA法及实时荧光定量PCR法检测血清标本中HBV标志物及HBV DNA水平;通过对组织标本的免疫组织化学染色检测组织中HBV标志物的表达。结果胎儿脐血HBV DNA水平与母血HBV DNA水平相关,母血HBV DNA高水平(≥107copy/mL)时脐血HBV DNA阳性率明显增高,P<0.05。胎儿脐血HBV DNA水平显著低于母血HBV DNA水平,P<0.05。胎盘组织可见HBsAg免疫组织化学染色阳性,但未发现HBcAg染色阳性。在引产胎儿胎肝和胎肾组织中发现HBsAg和/或HBcAg免疫组织化学染色阳性细胞。结论母亲HBV DNA高水平是发生HBV宫内感染的高危因素。脐血HBV DNA阳性是判断HBV宫内感染的相关指标;HBV可能通过胎盘感染的途径由母体进入胎儿体内,并可能在胎儿体内定位和复制,这可能是导致HBV宫内感染的原因。

Objective To study the mechanism of HBV markers in the fetus and fetal appendage. Methods HBV intrauterine infection by the detection of HBV markers and HBV DNA level in the serum were detected by ELISA and real time fluorescent quantitated PCR separately; the expression of HBV markers in the tissues was detected by immunohistochemical staining. Results The HBV DNA level in the cord blood was related with that in the maternal blood. When HBV DNA level was higher than 10^7copy/ ml, the rate of HBV DNA positivity in cord blood was much higher, with a statistical difference （P〈 0.05）. HBV DNA level in cord blood was much lower than that in maternal blood （P〈0.05）. HBsAg was detected in the placenta by immunohistochemical staining, but HBcAg was not. HBsAg and/or HBcAg were also found in the liver and kindney of the fetus by immunohistochemical staining. Conclusion One of the high risk factors of HBV intrauterine infection was the high level of HBV DNA in the serum of the mother. HBV DNA positivity in the cord blood was a related index of HBV intrauterine infection. The fetus might be infected through the route of placental infection, and HBV might locate and duplicate in the fetus. This might be the reason for the intrauterine infection of HBV.