孕期人乳头状瘤病毒亚临床感染的母婴传播及对胎婴儿的影响

Vertical Transmission and Effects on Fetus and Infant of Human Papillomavirus Asymptomatic Infection during Gestational Periods

目的 探讨孕中期、孕晚期人乳头状瘤病毒亚临床感染的母婴垂直传播情况及对胎婴儿的影响。方法 采用多聚酶链反应技术对 42例孕中期、32例孕晚期妇女的宫颈分泌物、母血、胎盘、羊水、脐血、新生儿咽部分泌物标本进行HPV - 6、11、16、18型DNA检测。结果 孕中期 :12例宫颈分泌物HPV阳性 (12 / 42 ) ,11例母血HPV阳性 (11/ 42 ) ,9例胎盘组织HPV阳性 (9/ 42 ) ,2 2例羊水标本中 ,仅 1例羊水HPV阳性 (1/ 2 2 ) ;孕晚期 :2 3例宫颈分泌物HPV阳性 (2 3/ 32 ) ,18例母血HPV阳性 (18/ 32 ) ,12例胎盘组织HPV阳性 (12 / 32 ) ,31例羊水及脐血标本中 ,4例羊水HPV阳性 (4/ 31) ,12例脐血HPV阳性 (12 / 31)。 17例异常胎婴儿中有 3例胎儿窘迫、1例新生儿高胆红素血症及 1例无脑畸形儿的脐血或胎盘组织HPV阳性。结论 孕期HPV感染的母婴传播不但可经产道直接接触传播 ,还可经血液、羊水及胎盘发生宫内传播 ,其宫内传播率的高低主要与母血的HPV感染相关。新生儿脐血的HPV感染主要与母血的HPV感染相关 ,而产时新生儿咽部的HPV感染主要与宫颈分泌物HPV感染相关。妊娠期HPV感染可能与胎儿窘迫、新生儿高胆红素血症。

Objective To investigate the vertical transmission and the effects on fetus and infant of Human Papillomavirus(HPV) asymptomatic infection during the second and third gestational periods.Methods Polymerase chain reaction(PCR) assay was employed to detect HPV-6,11,16,and 18 DNA in 42 pregnant women in the second trimester and 32 in the third.Samples from cervicalvaginal exfoliated cells,maternal peripheral blood,placenta,amniotic fluid,cord blood and nasopharyngeal secretion of the newborns were examined respectively.Results 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.Among 17 cases of malformed or at risk fetuses and infants,HPV-DNA was positive in 5 samples of neonatal cord blood or placenta,including 3 cases of fetal distress,1 case of neonatal hyperbilirubinemia and 1 case of anencephalus.Conclusion During pregnancy,HPV is transmitted from mother to fetus not only through the birth canal at birth but also through the blood,amniotic fluid and placenta during intrauterine life,and the HPV intrauterine transmission 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.A possible correlation exists between HPV infection in pregnancy and fetal distress,neonatal hyperbilirubinemia and fetal malformation.