乙型肝炎病毒感染产妇乳汁中乙型肝炎病毒DNA载量对母乳喂养的指导意义

Instructional significance of HBV-DNA load in maternal milk on breastfeeding of postpartum women infected with HBV

目的探讨乙型肝炎病毒（HBV）感染产妇乳汁中HBV-DNA病毒载量对母乳喂养的指导意义。方法对2008--2010年在某院住院的152例HBV感染产妇，采用荧光PCR技术检测其外周血清及乳汁中HBV—DNA病毒载量水平，并以1．0×10^3U／ml为判断临界值，分析血清和乳汁中HBV—DNA病毒载量之间的关系。结果152例HBV感染产妇血清和乳汁中HBV—DNA载量大于1．0×10^3U／ml者分别占50．66％（77／152）和36．18％（55／152）。血清和乳汁HBVDNA载量与乙肝病毒e抗原（HBeAg）是否阳性相关，HBeAg阳性时血清和乳汁中HBV—DNA载量大于1．0×10^3U／ml者分别占95．38％（62／65）和76．92％（50／65），HBeAg阴性时分别为17．24％（15／87）和5．75％（5／87）。血清HBV—DNA与乳汁HBV—DNA载量存在相关性，当血清HBV—DNA载量为3～4 lgU／ml时，乳汁中HBV—DNA检出率仅为20．00％（5／25），在血清HBV—DNA载量大于5lgU／ml时，乳汁中HBV—DNA检出率达96．15％（50／52）。结论HBV感染产妇乳汁中HBV—DNA载量随着血清中HBV—DNA载量升高而升高，当乳汁中存在HBV—DNA病毒大于1．0×10^3 U／ml时，应避免母乳喂养。

Objective To study the instructional significance of HBV-DNA load in maternal milk on breastfeeding of postpartum women infected with HBV. Methods HBV-DNA levels in serum and breast milk were detected by FQ-PCR in 152 postpartum women infected with HBV, and HBV-DNA ≥ 1.0 × 10^3 U/ml was defined as HBV positive. Correlation analysis was also conducted to estimate if there were relations in HBV levels in serum and breast milk. Results HBV-DNA positive rate were 50. 66% （77/152） and 36.18% （55/152） in serum and breast milk, respectively. When HBeAg was positive, HBV-DNA positive rate were 95.38% （62/65）and 76. 92% （50/65）in serum and breast milk; however when HBeAg was negative,HBV-DNA positive rate were 17.24% （15/87）and 5.75% （5/87）in serum and breast milk. When the concentration of HBV-DNA was 3 -4 lg U/ml in serum, HBV-DNA positive rate was 20. 00% （5/25）in breast milk; However, when the concentration of HBV-DNA was higher than 5 lg U/ml in serum,HBV-DNA positive rate was 96. 15% （50/52） in breast milk. Conclusion The HBV-DNA level in breast milk in postpartum women infected with HBV increased with the HBV-DNA levels in serum. Breastfeeding should be avoided when the concentration of HBV-DNA is higher than 1.0 ×10^3 U/ml in milk.