基于社区人群的慢性乙型肝炎病毒感染孕妇产前血清学及病毒学特征

Prenatal serological and virological characteristics of pregnant women with chronic HBV infection in community population

目的了解中国部分地区基于社区人群的未经抗病毒治疗的乙型肝炎(乙肝)病毒(HBV)表面抗原(HBsAg)阳性孕妇产前HBV血清学和病毒学特点。方法该研究从广西、江苏、河南地区入组1741例HBsAg阳性孕妇。所有孕妇的临产前血清样本采用Abbott Architect i2000和Abbott Architect m2000分别检测HBV血清学标志物及HBV DNA水平;采用型特异性引物巢式聚合酶链反应(n PCR)法进行HBV基因型分型。结果 1741例HBsAg阳性孕妇中,HBeAg阳性占37.0%(645/1741),HBeAg阴性孕妇占63.0%(1096/1741)。HBeAg阳性孕妇产前HBsAg滴度、HBV DNA水平以及B基因型孕妇所占比例均高于HBeAg阴性孕妇,但年龄低于HBeAg阴性孕妇。HBeAg阳性孕妇的HBsAg滴度和HBV DNA水平呈正相关(r=0.790,P<0.001),HBeAg滴度和HBV DNA水平也呈正相关性(r=0.564,P<0.001)。而HBeAg阴性孕妇的HBsAg滴度和HBV DNA水平无相关性(r=0.020,P=0.517)。结论未经抗病毒治疗的HBsAg阳性孕妇在不同HBeAg状态下,血清HBV DNA水平及HBsAg滴度分布各不相同。对于HBeAg阳性孕妇人群,HBeAg滴度、HBsAg滴度可能成为HBV DNA水平的替代指标。

Objective To investigate the prenatal serological and virological characteristics of HBsAg-positive pregnant women without in some areas in China. Methods A total of 1741 HBsAg-positive pregnant women were recruited from Guangxi, Jiangsu and Henan provinces. Serum samples were collected before labor for evaluation of pre-delivery ALT, HBV serological markers and HBV DNA. HBsAg, HBeAg and HBV DNA levels were tested by Abbott Architect i2000 and m2000 systems, respectively. HBV genotyping was performed by a method based on nested polymerase chain reaction （nPCR） established in our lab. Results Among 1741 HBsAg- positive women, 37.0%（645/1741） were HBeAg positive and 63.0%（1096/1741） were HBeAg negative, respectively. The median titers of HBsAg, HBV DNA levels and the proportion of genotype B in HBeAg-positive women were higher than those of HBeAg-negative women, but the age of HBeAg-positive women was younger than that of HBeAg-negative ones. The proportion of HBeAg-positive women was gradually declining with the increase of age. HBsAg titers and HBeAg taters were positively correlated with HBV DNAlevels in HBeAg-positive group （r=0.790, P〈0.001; r=0.564, P〈0.001）. However, there was no correlation between HBsAg titers and HBV DNA levels in HBeAg-negative group （r=0.020, P=0.517）. Conclusion The serological and virological characteristics of treatment- naive HBsAg-positive women differed by the HBeAg status.Quantitative HBsAg titer and HBeAg titer might be surrogate markers for HBV DNAlevels in HBeAg-positAve women.