HBV感染母亲的血清病毒状态对新生儿HBV血清标志物的影响

Effects of states of HBV infection in mothers' infected with hepatitis B virus on serum markers of HBV in neonates

目的观察母亲血清HBV标志物(HBVM)及HBV DNA对新生儿静脉血HBVM的影响,探讨新生儿血清HBVM检测的临床意义。方法选择于本院分娩的HBsAg阳性母亲,根据其新生儿出生7个月后HBVM检测,分为HBV感染组和免疫成功组,对两组母亲及其新生儿的血清HBVM、HBV DNA及母婴传播情况进行回顾性分析。结果 HBV感染组和免疫成功组母亲HBeAg阳性率分别为97.1%和43.7%;HBV DNA阳性率分别为97.1%和16.2%。母亲血清HBV DNA水平越高,新生儿HBV感染率也越高(χ2=392.56,P<0.0001)。HBV感染组新生儿出生时血清HBsAg、HBeAg、抗-HBe和HBV DNA的阳性率显著高于免疫成功组(P均<0.0001);尤其是HBV DNA,HBV感染组的新生儿出生时HBV DNA 100%为阳性,而410例免疫成功组新生儿仅1例出生时HBV DNA为阳性(3.67×103拷贝/ml)。在免疫成功组的新生儿中,HBsAg阳性率只有11.0%,HBeAg阳性率为34.9%,而免疫成功组和HBV感染组新生儿血清抗-HBc阳性率分别为98.8%和100%,两组差异无统计学意义(χ2=0.4317,P=0.663)。结论 HBV母婴阻断失败与母亲HBeAg阳性和HBV DNA水平有关。胎盘对HBV抗原及其抗体有选择的通透性,HBsAg不易透过胎盘,HBeAg可以部分透过胎盘进入胎儿体内,抗-HBc可以自由从母血中透过胎盘。新生儿出生时静脉血HBV DNA阳性和(或)HBsAg、HBeAg同时阳性可以预测新生儿的宫内感染和HBV免疫失败。

Objectives To investigate the effect of mother’s serum HBV markers （HBVM） and HBV DNA on newborn venous blood HBVM, and to discuss the clinical signiifcance of newborn HBVM detection.Methods The mothers who deliveried at our hospital were divided into HBV-infected group and immune-success group according to the HBVM conditions of 7-month-old newborns. The newborn serum HBVM, HBV DNA and maternal-neonatal transmission situation between the two groups were analyzed, retrospectively.Results The HBeAg positive rates of HBV-infected group and immune-success group were 97.1% and 43.7%, respectively. The positive rates of HBV DNA were 97.1% and 16.2%, respectively. And the results also showed that the higher serum HBV DNA level of mothers, the higher HBV infection rate of newborn （χ2= 392.56,P 〈0.0001）. The positive rates of serum HBsAg, HBeAg, anti-HBe and HBV DNA in HBV-infected group were all higher than those in immune-success group. Specially, all of the newborns in HBV-infected group gave the 100% positive rate of HBV DNA, while there was only 1 positive case in immune-success group and the HBV DNA level was 3.67 ＆#215; 103copies/ml. Among the immune-success newborns, the positive rates of HBsAg and HBeAg were 11.0% and 34.9%, respectively. The serum anti-HBc positive rates in HBV-infected group and immune-success group were 98.8% and 100%, respectively, with no signiifcant differences （χ2= 0.4317,P = 0.663）.Conclusions Interdiction of maternal-neonatal transmission （PMTCT） failure is related to HBeAg positive and mother’s HBV DNA level. Placenta has selective permeability for HBV antigens and antibodies. It is dififcult for HBsAg to pass through placenta. HBeAg could partly across placenta into fetal body. Anti-HBc could across placenta from mother’s blood freely. The conditions of venous blood HBV positive and/or HBsAg-HBeAg double positive at birth might have predictive value for intrauterine infection and HBV immune failure of newborns.