HBV感染者胚胎中HBV DNA的测定及其相关因素分析

Detection of HBV DNA in human embryos and analysis of risk factors of HBV vertical transmission

目的检测父/母为乙型肝炎病毒(HBV)慢性感染者的胚胎中是否存在HBV DNA,探讨HBV经配子垂直传播的可能性,同时评估影响垂直传播发生的相关因素。方法收集单方HBV感染的229对夫妻的310个废弃胚胎。采用套式聚合酶链反应(PCR)法测定胚胎样本中的HBV DNA。采用Logistic回归分析患者年龄、血清HBV DNA载量、血清HBV多种抗原或抗体存在情况及授精方法等因素与HBV DNA存在的相关性。结果 7.74%(24/310)的胚胎中检出了HBV DNA;血清HBV DNA载量与胚胎中存在HBV DNA呈显著正相关[OR4.128,95%CI(1.319,12.914),P=0.015];授精方式(IVF或ICSI)的差异对胚胎HBV DNA阳性检查率几乎无影响(P>0.05);同一对夫妻的多个胚胎中只有部分胚胎存在HBV DNA。结论垂直传播可能是HBV重要的传播途径之一。对于HBV DNA高载量的父/母,自然受孕或助孕治疗前建议进行针对性治疗,以降低胚胎感染HBV的风险。

Objective. To detect whether hepatitis B virus （HBV） DNA exists in the embryos of the parents infected by HBV,and explore the passibility of HBV vertical transmission via the germ cell. Methods： A total of 310 human embryos from 229 couples, in whom one of the spouses exhibited seropositive hepatitis B surface antigen （HBsAg） ,were collected. HBV DNA in the embryos was detected by nested PCR. The correlation between the influence factors including patient age, serum HBV DNA load, serum HBV antigen/antibody level ＆ insemination method and the presence of HBV DNA in embryos were evaluated by logistic regression analysis. Results： HBV DNA was exhibited in 7.74% （24/310） of embryos. HBV DNA load in embryos were significantly positively correlated with the serum HBV DNA level （OR 4. 128,95% CI： 1. 319-12. 914,P= 0. 015）. The insemination mode （IVF or ICSI） was not significantly related with HBV DNA positive rate in embryos （P〉0.05）. HBV DNA was only presented in part of embryos of the same parents with high serum HBV DNA level. Conclusions： Vertical transmission is one of the important routes of HBV transmission. The targeted therapy should be recommended before natural conception or IVF treatment for the parents with high load of HBV DNA to reduce the risk of HBV infection to embryos.