宫内感染乙型肝炎病毒新生儿发育指标的观察

An observation on the developmental indexes of neonates infected with hepatitis B virus in uterus

目的观察宫内感染乙型肝炎病毒（ＨＢＶ）新生儿发育指标降低与母婴ＨＢＶ感染状态和感染孕周的关系。方法将１３７例孕中期ＨＢＶ标志物阳性孕妇足月分娩后与其婴儿配对，用ＥＬＩＳＡ法检测ＨＢＶ标志物，其中４０对用聚合酶链反应（ＰＣＲ）技术检测ＨＢＶＤＮＡ；对照组ＨＢＶ标志物和ＨＢＶＤＮＡ均为阴性者共７３对。观察组和对照组新生儿出生后均按规范要求测量体重、身长和头围。结果观察组新生儿ＨＢＶ标志物阳性率２０％（２７／１３７），ＨＢＶＤＮＡ阳性率４８％（１９／４０）；两种方法检出的宫内感染儿发育指标降低率分别为３３％（９／２７）和３２％（６／１９），其差异无显著意义（Ｐ＞０．０５）。发育指标降低的宫内感染儿均显示ＨＢＶ处于复制状态。对照组新生儿无ＨＢＶ标志物和ＨＢＶＤＮＡ阳性标本检出，仅１例（１／７３）表现为体重降低。结论宫内感染儿发育指标降低特点表现为３项指标同时降低或身长、头围降低，提示胎儿宫内ＨＢＶ急性感染后病毒血症期，病毒在胎儿体内呈高水平复制时干扰细胞分裂与增殖，尤其影响细胞增生旺盛期身长和大脑发育。

Objective To observe the association of the depression of developmental indexes of neonates infected with HBV in uterus with the situation of the mothers and their infants in relation to gestational weeks of infection. Methods HBV markers were examined after labour in 137 mothers with positive HBV markers in their mid pregnancy, and paired with their infants. HBV DNA was examined in 40 pairs with PCR technique. The control group consisted of 73 pairs whose HBV markers and HBVDNA were both negative. After delivery, the weight, length and head circumference of the neonates in both groups were measured. Results In the group of neonates observed the positive rates of HBV markers and HBVDNA were 20% (27/137) and 48%(19/40), respectively. The depression rates of developmental indexes in HBV marker and HBV DNA positive neonates were 33% (9/27) and 32%(6/19), respectively ( P >0.05). HBV in these infants was in replication. Neither positive HBV markers nor HBV DNA was demonstrated in controls, of whom 1 case had weight depression. Conclusion The depression of developmental indexes in neonates infected in uterus was characterised by depression of all the 3 parameters, or depression in the body length and head circumference, which suggests that in the period of acute viremia, when HBV replicated highly in fetus, the division and proliferation of their cells were interfered, which especially affects the body length and brain development.