孕期人乳头状瘤病毒亚临床感染与母婴垂直

Vertical transimission of human papillomavirus asymptomatic infection during different gestational periods

目的 :探讨不同孕期人乳头状瘤病毒 ( HPV)亚临床感染及母婴垂直传播情况。方法 :采用 PCR技术检测 3 0例孕早期、 4 2例孕中期、 3 2例孕晚期妇女的宫颈分泌物、母血、绒毛或胎盘、羊水、脐血及新生儿咽部抽吸物标本 HPV- 6、 11、 16、 18型 DNA。结果 :早孕期 :5例宫颈分泌物 HPV阳性 ( 5 /3 0 ) ,7例母血 HPV阳性 ( 7/3 0 ) ,3例绒毛 HPV阳性 ( 3 /3 0 ) ;中孕期 :12例宫颈分泌物 HPV阳性 ( 12 /4 2 ) ,11例母血 HPV阳性 ( 11/4 2 ) ,9例胎盘 HPV阳性 ( 9/4 2 ) ;另 2 2例羊水标本中 ,仅 1例 HPV阳性 ( 1/2 2 ) ;晚孕期 :2 3例宫颈分泌物 HPV阳性( 2 3 /3 2 )、 18例母血 HPV阳性 ( 18/3 2 ) ,12例胎盘 HPV阳性 ( 12 /3 2 ) ;另 3 1例羊水标本中 ,4例 HPV阳性 ( 4 /3 1) ,3 1例脐血标本中 ,12例 HPV阳性 ( 12 /3 1)。分析羊水、脐血与母血 HPV感染的相对危险度高于宫颈分泌物 ,而产时新生儿咽部抽吸物与宫颈分泌物 HPV感染的相对危险度高于母血。结论 :在整个孕期中 ,孕晚期的HPV亚临床感染明显。孕期 HPV亚临床感染的母婴传播不但可经产道直接接触传播 ,还可经羊水、胎盘发生宫内传播 ,其宫内传播率的高低主要与母血 HPV感染相关。新生儿脐血的 HPV感染主要与母血感染相关 ,而产时新生儿咽部的

Objective:To investigate the vertical transmission of Human Papillomavirus (HPV) asymptomatic infection of different gestational periods. Methods:Polymerase chain reaction (PCR) assay was employed to detect HPV DNA 6, 11, 16, and 18 in 30 pregnant women in the first trimester, 42 in the second and 32 in the third. Samples from cervicalvaginal exfoliated cells, maternal peripheral blood, chorionic villi or placenta, amniotic fluid, cord blood and nasopharyngeal secretion of the newborns were examined respectively. Results:In the first trimester, HPV DNA was detected in the cervicalvaginal exfoliated cells of 5 cases (5/30), in maternal peripheral blood of 7 cases (7/30) and in chorionic villi of 3 cases (3/30). In the second trimester, HPV DNA was detected in the cervicalvaginal exfoliated cells of 12 cases (12/42), in maternal peripheral blood of 11 cases (11/42), in placenta of 9 cases (9/42). Only one of 22 amniotic fluid samples was found infected (1/22). In the third trimester, HPV DNA was detected in the cervicalvaginal exfoliated cells of 23 cases (23/32), in maternal peripheral blood of 18 cases (18/32), in placenta of 12 cases (12/32). 4 samples of amniotic fluid out of the 31 cases (4/31) and 12 cord blood samples (12/31) were found infected. The risk of HPV infection in the amniotic fluid as well as the neonatal cord blood was related to the status of HPV infection in the maternal peripheral blood, being significantly higher than the relation to the maternal cervicalvaginal cells samples. The risk of HPV infection in the neonatal nasopharyngeal aspirates at birth was more highly related to the infective status of HPV in the maternal cervicalvaginal cells samples than to that of the maternal peripheral blood. Conclusion:Asymptomatic in fective rate of HPV is highly siginificant in the third trimester. In pregnant women, HPV is transmitted not only through the birth canal at birth but also through the amniotic fluid and placenta during intrauterine life, and the HPV intrauterine transimission rate is related mainly to the state of HPV infection in the maternal peripheral blood. HPV infection in the neonatal cord blood is closely related to the status of HPV infection in the maternal peripheral blood, while HPV positive in the neonatal nasopharyngeal aspirates at birth correlates closely with the HPV infective state in the maternal cervicalvaginal cells.