乙肝病毒携带产妇血清标志物模式与血清及乳汁HBV-DNA相关性研究

Study on the hepatitis B serum markers and the correlation between serum and milk HBV-DNA in HBV-infectious pregnant women

目的通过检测分析乙肝病毒携带产妇血清学标志物与血清、乳汁HBV-DNA阳性率的关系,以及产妇血清与乳汁中HBV-DNA含量之间的相关性,旨在指导母乳喂养。方法选取96例乙肝病毒携带产妇,将其分为大三阳组(54例)、小三阳组(25例)、HbsAg和HbeAg均阳性组(8例)及HbsAg和HbcAb均阳性组(9例)。另选取12例乙肝两对半全阴的产妇作为对照组。ELISA法检测乙肝病毒携带产妇乙肝免疫血清学标志物,实时荧光定量PCR法分别检测产妇血清与乳汁中HBV-DNA含量,并对所有检测指标进行相关性分析。结果大三阳组产妇血清和乳汁HBV-DNA阳性率明显高于其他三组(P<0.05)。乳汁HBV-DNA在各组中检出的阳性率均小于血清HBV-DNA,但两者差异无统计学意义(P>0.05)。根据乙型肝炎血清学标志物HBeAg是否阳性将96例产妇分为HBeAg阳性组(62例)和HBeAg阴性组(34例),血清HBeAg阳性产妇的血清和乳汁中HBV-DNA阳性率均明显高于HBeAg阴性产妇,差异具有统计学意义(P<0.01)。但一部分血清HBeAg阴性产妇血清和乳汁中HBV-DNA亦为阳性。产妇血清与乳汁中HBV-DNA含量呈正相关(r=0.891,P<0.05)。结论乙肝病毒携带产妇乳汁HBV-DNA检出的阳性率低于血清HBV-DNA,且乳汁HBV-DNA含量随血清HBV-DNA含量的升高而增大,因此定量双重检测产妇血清、乳汁中HBV-DNA来确定母婴乙肝病毒传播的风险性更为可靠,这将有利于阻断乙肝传播,确定哺乳方式,指导母乳喂养,从而降低乙肝新生儿感染率。

Objective Through analysis of the relationship between the hepatitis B serum markers in HBV-infectious pregnant women and the HBV-DNA positive rate in serum and milk, and the correlation serum and milk HBV-DNA in HBV-infectious pregnant woman, we aimed to explore some instructions on breast-feeding. Methods Ninety-six HBV-infectious pregnant women were divided into four groups, including large three-positive group, small three-positive group, HbsAg and HbeAg positive group, and HbsAg and HbcAb positive group. Another 12 women with hepatitis B two pairs of semi-five indicators all negative were chosen as control group. The hepatitis B virus immune markers in serum were detected by ELISA while HBV-DNA level in serum and milk was determined by real time RT-PCIL and the correlation between the detecting results were analyzed. Results The positive rates of HBV-DNA in serum and milk of large three positive group were significantly higher than those in the other three groups （P〈0.05）. Among all groups, the positive rates of HBV-DNA in milk were less than those in serum with no significant difference （P〉0.05）. The HBV-DNA positive rates in serum and milk in HBeAg positive groups were obviously higher than that in HBeAg-negative group （P〈0.01）. However, HBV-DNA in serum and milk were also detected in part of the HBeAg-negative pregnancy women. The HBV-DNA content in serum had positive relation with HBV- DNA content in milk （r=0.891, P〈0.05）. Conclusion In HBV- infectious pregnant women, it is found that the HBV-DNA positive rate in milk was less than that in serum, and the content of HBV-DNA in milk was increased along with that increased in serum. Therefore, it is more reliable to determine the risk of hepatitis B virus transmission from mother to infant by quantitative measurement of HBV-DNA in serum and milk. It is helpful in interrupting HBV transmission, deciding the mode of breast-feeding, and guiding breast-feeding, so as to decrease the infectious rate of baby.