江苏地区孕中期孕妇抗-HEV阳性率及分娩后6年随访观察

Prevalence of anti-HEV in the second trimester pregnant women in Jiangsu province of China and a 6-year follow-up

目的调查江苏省孕妇人群戊型肝炎病毒（HEV）感染情况,并观察孕妇产后及其子女的血清学标志变化。方法纳入497例2002年8月~2004年7月采集血清的孕中期孕妇,并于2009年10月~2010年3月进行随访,同时对其子女随访。用重组4型HEV ORF2蛋白主要抗原决定簇多肽及其截短多肽为包被抗原的ELISA法,初筛血清抗-HEV IgM和IgG,初筛阳性样本用Western blotting确认;RT-PCR检测血清HEV RNA。结果 497例孕中期孕妇平均年龄（25.0±3.0）岁,产后随访年龄（31.7±3.5）岁。孕中期抗-HEV IgM阳性3例（0.60%）,抗-HEV IgG阳性55例（11.07%）。产后随访时分别有2例抗-HEV IgM和18例抗-HEV IgG由阳性转为阴性,另外各有2例抗-HEV IgM和18例抗-HEV IgG由阴性转为阳性,故产后随访时抗-HEV IgM阳性仍为3例（0.60%）,抗-HEV IgG阳性仍为55例（11.07%）,该人群6年累计抗-HEV IgG阳性73例（14.69%）。随访的497例儿童平均年龄（6.0±0.6）岁,抗-HEV IgM阳性1例（0.20%）,抗-HEV IgG阳性2例（0.40%）。3例孕中期抗-HEV IgM和IgG同时阳性孕妇未发生妊娠或新生儿不良事件,随访时其子女抗-HEV IgM和IgG均为阴性;18例随访期间抗-HEV由阴性转为阳性母亲的子女抗-HEV均为阴性。抗-HEV IgM阳性血清均未检测到HEV RNA。结论与我国报道的普通人群抗-HEV IgG阳性率（20%~40%）相比,江苏地区孕妇HEV既往感染率较低。母亲与子女间发生家庭内病毒传播的可能性较小。

Objective To study the prevalence of HEV infection among pregnant women in Jiangsu province of China,and to observe postpartum anti-HEV evolution in these women and their children. Methods Serum samples of 497 mid trimester pregnant women,collected from August 2002 to July 2004,and 497 paired sera of mothers and children,collected from October 2009 to March 2010,were tested for anti-HEV IgG and IgM by in-house ELISA.In-house ELISA was based on the recombinant HEV ORF2 immunodominant polypeptide and the truncated immunodominant polypeptide.Anti-HEV positive samples by ELISA were confirmed by Western blotting.HEV RNA was detected by RT-PCR. Results The average age of 497 women was 25.0±3.0years old during their second trimester pregnancy and 31.7±3.5years in the follow-up study.During the pregnancy,3（0.6%）were anti-HEV IgM positive and 55（11.07%）anti-HEV IgG positive.At the followup stage,two of the three IgM-positive women became negative,yet two other women showed anti-HEV IgM positive.In addition,18IgG-positive women became anti-HEV IgG negative and 18 other seronegative women converted to anti-HEV IgG positive.Thus,there were still 3（0.6%）anti-HEV IgM positive and 55（11.07%）anti-HEV IgG positive at the follow-up stage,the accumulated positive rate during the 6.7-year period was 14.69%（73/497）.Of the 497 children at the average age of 6.0±0.6years old,only one（0.2%）was anti-HEV IgM positive and two（0.4%）anti-HEV IgG positive.No adverse pregnant and neonatal outcomes were observed in the three IgM-positive pregnant women and their children.None of the 18 children whose mothers underwent postpartum anti-HEV IgG seroconversion was anti-HEV positive.None of the antiHEV IgM positive samples had detectable HEV RNA. Conclusions The anti-HEV IgG prevalence of pregnant women in Jiangsu province of China was relatively low comparing to that（20%-40%）reported in the general adults in China.The intra-family transmission of HEV from subclinically infected mothers to children is rare.