HBeAg阴性的HBV感染产妇与母婴传播关系

Relationship between HBeAg negative HBV infectious pregnant women and their mother-to-infant infection

目的探讨HBeAg检测阴性的乙型肝炎病毒（HBV）感染产妇及其存在的前C区1896位终止变异株与母婴传播的关系。方法采用实时荧光定量PCR方法测定产妇血中HBV-DNA载量,对HBV-DNA阳性者及其感染的婴儿,利用错配PCR限制性片段长度多态性分析,测定HBV前C区1896位终止变异。结果HBeAg阴性产妇HBV的母婴传播率为5.75%,而且母婴传播概率与产妇血中HBV载量密切相关,高载量组（≥10^6拷贝/ml）的传播率为34.7%,明显高于低载量组（10^4～10^6拷贝/ml）的17.1%和低于检测值组的0.46%（P〈0.01）,进一步对存在HBV前C区终止变异的产妇及其所感染的新生儿的HBV基因分析,发现5例野生株占优势的HBV感染产妇,所感染的婴儿均为野生株,4例变异株占优势的产妇,其感染的婴儿2例为变异株感染,2例为野生株感染。结论HBeAg阴性的HBV感染产妇存在母婴传播的危险性与其体内的HBV-DNA载量密切相关,对于存在前C区终止变异的HBV感染产妇,在母婴传播过程中,野生株比变异株更容易感染胎儿。

Objective To evaluate HBeAg negative HBV infectious pregnant women with or without pre-C 1896＂stop＂ mutation and their mother-to-infant infection.Methods HBV-DNA load in blood of pregnant women was detected by real time fluorescence quantitative PCR.HBV pre-C 1896 ＂stop＂ mutation of the HBV positive mother and their HBV infected infants was analyzed by mismatched PCR restricted fragment length polymorphous assay.Results The rate of HBV mother-to-infant infection with HBeGg negative pregnant women was 5.57%.The higher infection rate was,the higher HBV was loaded in blood of pregnant women.The infection rate of HBV high load group（≥10^6 copies/ml） was 34.7%,which was higher than that of low load group（10^4～10^6 copies/ml,17.1%）（P〈0.01）.HBV gene of HBV infected pregnant women with ＂stop＂ mutate and their newly-born babies was analyzed,and found that all of the five HBV infected infants delivered by wild strain advantage mothers were tested as wild strain HBV carriers.Among four mutant strain advantage HBV infected mothers,two of their infants were found to have mutant strain HBV infection,and the other two as wild strain infection.Conclusion The risk of mother-to-infant HBV infection with HBeAg negative mother is related to mother＇s HBV load in the blood.For co-infected HBV pregnant women with ＂stop＂ mutant strain and wild strain,mother-to-infant infection of wild stain HBV occurred more easily than that of mutant strain.