围生期产妇血清、乳汁、唾液乙肝病毒标志物间的关联性

The relationship among the markers of hepatitis B virus in serum,breastmilk,saliva of the perinatal women with hepatitis B virus

目的:研究围产期产妇血清、乳汁、唾液中乙肝病毒标志物及核酸DNA载量关联性,为科学指导新生儿母婴喂养、母婴接触方式提供循证医学证据。方法:在知情同意的原则下选择住院分娩产妇612例作为乙肝研究对象,根据产妇乙肝五项不同模式分为A、B、C、D、E 5组,采用ELISA法检测各组产妇血清、乳汁、唾液中HBV标志物HBsAg、HBsAb、HBeAg、HBeAb、HBcAb,同时应用实时荧光定量PCR检测其HBV-DNA载量。结果:各组的产妇血清、乳汁、唾液HBV-DNA阳性率分别是A组99.33%、89.15%、96.49%;B组20.00%、3.11%、54.24%;C组65.52%、27.66%、29.41%;D组13.56%、3.45%、0.00%;E组1.16%、0.00%、0.00%。A组与B组间血清与乳汁HBV-DNA差别有统计学意义(χ2=237.45,P<0.01);血清与唾液间HBV-DNA差别有统计学意义(χ2=289.49,P<0.01)。产妇乳汁、唾液HBV-DNA载量与其血液HBV-DNA载量呈正相关;研究证实A组产妇经母乳乙肝病毒传染性是乙肝"小三阳"产妇的87.45倍,乙肝病毒其他模式者乳汁传染性与乙肝"小三阳"产妇乳汁传染性相近。结论:①携带乙肝病毒的产妇乳汁、唾液有潜在传染性,其HBV-DNA载量远低于产妇血液HBV-DNA含量;②产妇乳汁、唾液中乙肝病毒DNA阳性率与母血中HBV-DNA载量呈正相关;③产妇血液HBV DNA≥1.00×103 copies/ml,建议人工喂养;④携带乙肝病毒的产妇不要对婴儿口对口喂食,亲吻等亲密接触方式,以防血液、唾液等途径传染乙肝病毒;⑤检测唾液可代替乳汁检查,唾液取材方便,唾液乙肝传染性比乳汁略强,孕期检测唾液HBV DNA载量,可提前为婴儿喂养方式、母婴接触方式、优生优育等提供循证医学证据;⑥携带乙肝病毒者哺乳期要定期检测产妇唾液、乳汁。

Objective：To study the relationship among the markers of hepatitis B virus in serum,breastmilk,saliva of the perinatal women with hepatitis B virus（HBV）,in order to provide to basis for guiding feeding new-born and the way of contacting new-born for mothers. Methods：612 parturients with HBV were divided into 5 groups. with HBsAg HBsAb,HBeAg,HBeAb,HBcAb and HBV sign thing in ELISA law detection lying-in woman serum,milk and saliva,at the same time,measure with its fluorescence by ration PCR detection HBV-DNA year of real time,for being related data make statistics of analysis basis lying-in woman Hepatitis B Virus 5 different patterns divide into A,B,C,D and E totally 5 groups. Results：The positive rate of HBV-DNA in serum,breastmilk,saliva was 99.33%,89.15%,96.49% respectively in group A;20.00%,3.11%,54.24% in group B;65.52%,27.66%,29.41% in group C;13.56%,3.45%,0.00% in group D;1.16%,0.00%,0.00% in group E.The content of HBV-DNA in breastmilk and saliva were positively related to those in serum.The study confirmed that the infectious of HBV through breastmilk of the parturients in group A was 87.45 times of the parturients with ＂small three positive＂. Conclusion：①Breastmilk and saliva of the parturients with HBV have potential infectious.The content of HBV-DNA in them are much lower than in serum.②The positive rates of HBV-DNA in breaskmilk and saliva of parturients are positively related with that in serum.③HBV-DNA in serum of parturients was ≥ 1.00 х 103 copies/ml,so the artificial feeding should be done.④The parturients with HBV should not feed infant by mouth to mouth.⑤Detecting saliva can be used instead of detecting breastmilk.⑥Breast feeding women with HBV should regularly detect serum and breastmilk.