胎儿感染乙型肝炎病毒的临床研究

Analysis about clinical data of intrauterine infection of hepatitis B virus

目的 探讨临床诊断胎儿感染乙型肝炎病毒 (HBV)的方法 ,及其与各种临床因素的相互关系。方法 采用聚合酶链反应 (PCR)及斑点杂交法 ,检测 14 1例HBV携带者孕妇及其分娩的 14 4例新生儿静脉血HBVDNA、HBV标志物及肝功能。其中 4 0例新生儿同时留取脐带血及出生后 2 4～4 8h外周静脉血用于检测HBVDNA。 14 4例新生儿根据有无HBV感染分为胎儿感染组及对照组 ,比较两组新生儿的临床资料及其肝转氨酶水平。结果 (1) 14 4例新生儿中有 33例发生宫内HBV感染(胎儿感染组 ) ,感染率为 2 2 9% ;无宫内HBV感染 111例 (对照组 )。 4 0例新生儿脐血与外周静脉血HBVDNA阳性率相比 ,脐血的假阳性率为 2 0 0 % ,其敏感性、阳性预测值分别为 10 0 0 %、80 0 %。追踪HBV携带者孕妇所分娩的新生儿出生 6～ 9个月后 ,HBVDNA持续阳性者 7例 (7/2 8) ,抗 HBs转阳率为 85 3% ;出生时HBsAg阳性者 5例 ,均于 1个月后转为阴性。 (2 )在HBeAg或HBVDNA阳性孕妇中 ,其胎儿感染率分别为 70 5 %、6 1 1% ,显著高于HBeAg或HBVDNA阴性者的 2 0 % (2 /10 0 )、0 0 %(P <0 0 1)。胎儿感染组与对照组孕妇 ,在年龄、孕周、分娩方式、出生体重、身长、出生 1分钟Apgar评分等比较 ,差异均无显著性 (P >0 10 )。 (3)胎儿感染组天?

Objective To investigate a practical diagnostic method in clinic for fetuses infecting with hepartitis B (HBV) and study the mutual effects between fetal infection and clinical factors Methods Venous blood was drawn from 144 cases of HBV carrier mothers and their neonates. HBV DNA was detected by polymerase chain reaction (PCR) and hybridization, HBV M was detected by enzyme linked immunoadsorbent assay (ELISA), and aspartate aminotransferase/alanine aminotransferase (AST/ALT) was detected by IFCC. Umbilical blood and femoral blood was taken from 40 of 144 neonates for HBV DNA detection. Clinical data, neonatal AST and ALT level were compared between fetal infection group and control group. Results (1) The fetal infectious rate was 22 9% (33/144). Comparing with peripheral venous blood sample, the sensitivity and positive predictive value of HBV DNA detected in cords was 100 0%, 80 0% respectively. Following up the infants, HBV DNA was found persistently positive in 7 of 28 intrauterine infectious infants 6～9 months after birth. HBsAg was found changing to be negative 1 month later in the infants with HBsAg positive at birth. (2) The fetal infectious rate in mothers with HBeAg(+) or HBV DNA(+) was 70 5%, 61 1% respectively which was significantly higher than that in monthers with HBeAg(-) or HBV DNA (-). P <0 01. There was no significantly difference in mothers′ age, gestational age, delivery way, birth weight (BW), body length (BL), Apgar score between fetal infectious group and control group. (3) The mean value of AST, ALT in fetal infectious group was (61 2±31 3) IU, (24 7±14 9) IU respectively, which was significantly higher than that in control group [(55 2±37 1) IU, (19 0±10 1) IU]. P <0 01. Conclusions (1) Detection of HBV DNA in cord blood is a sensitive index for diagnosing fetal infection, however detection of peripheral venous blood is with the significance of making correct diagnosis. (2) HBsAg or HBV DNA positive in mothers is one of the risk factors of intrauterine infection. There is no relationship among fetal infection and mothers′age, gestational age, delivery way, neonates′sex, BW, BL. (3) The liver function of neonates infected with HBV intrauterinely maybe impaired to some extent.