分娩及产后7个月～12个月母婴戊型肝炎病毒抗体的动态观察

Dynamic monitoring of anti-HEV in mothers and their newborns from delivery to postpartum 7-12 months

目的调查江苏地区孕妇人群分娩时及产后7个月~12个月母婴戊型肝炎病毒（HEV）感染状况,并观察母源性抗-HEV Ig G抗体的胎盘通过以及在新生儿体内的衰减情况。方法纳入江苏省6个县市住院分娩的552例孕妇,采分娩时母血及脐血,并于产后平均为9.8个月（7个月~12个月）对母婴进行随访。采用ELISA法初筛血清抗-HEV Ig G和Ig M抗体,初筛阳性血清进一步采用Western blotting确认。结果所有孕妇抗-HEV Ig M均阴性,60例（10.9%）抗-HEV Ig G阳性。分娩时抗-HEV Ig G阳性的36例孕妇产后随访时仍阳性;分娩时抗-HEV Ig G阴性的212例孕妇产后随访时抗-HEV Ig M均阴性,3例（1.4%）抗-HEV Ig G转阳。60例抗-HEV Ig G阳性孕妇的新生儿脐血抗-HEV Ig G阳性57例（95.0%）,33例产后随访均转为阴性。随访215例脐血抗-HEV Ig G阴性新生儿,抗-HEV Ig G及Ig M均阴性。结论江苏省孕妇人群抗-HEV Ig G血清流行率为10.9%,孕期新发感染极低。母源性抗-HEV Ig G抗体可高效通过胎盘,在10月龄前转阴。婴儿几乎不发生HEV感染。

Objective To investigate the infection of anti- HEV among mothers and their newborns from delivery to postpartum7- 12 months in Jiangsu province,and to observe the decay of maternal anti- HEV Ig G antibody through the placenta and in the newborns. Methods 552 pregnant women who were hospitalized to delivery in 6 counties in Jiangsu were seclected,and the serum samples from maternal blood and umbilical cord blood during delivery were collected,after average 9. 8 months of the delivery（ 7- 12 months）,the mother and child were followed up randomly. Anti- HEV Ig G and Ig M were tested by ELISA at first. Anti- HEV positive samples tested by ELISA were further confirmed by Western blotting. Results All pregnant women were negative for anti- HEV Ig M and 60（ 10. 9%） were anti- HEV Ig G positive. All of the 36 Ig G positive women were still positive for anti- HEV Ig G at the postpartum follow- up. Of the 212 anti- HEV Ig G negative women at delivery,all were anti- HEV Ig M negative at the follow- up and 3（ 1. 4%） converted to anti- HEV Ig G positive. Of 60 neonates born to mothers with positive anti- HEV Ig G,57（ 95. 0%） were also positive in their cord blood. 33 cases of postpartum converted to negative at the postpartum follow- up. and all 215 neonates with cord blood anti- HEV negative were anti- HEV negative at the postpartum follow- up. Conclusions The prevalence of anti- HEV Ig G in pregnant women in Jiangsu was 10. 9% and recent infection in pregnancy was extremely low. Maternal anti- HEV Ig G may efficiently transfer through placenta to fetus and converted to be negative before 10 months old. HEV infection rarely occurs in infants.