HBsAg阳性孕妇血HBV-DNA含量及胎盘组织TLR3、TLR4表达与HBV宫内感染关系

Relationship between blood HBV-DNA, expression of TLR3 and TLR4 in placenta tissue and intrauterine HBV infection in HBsAg-positive pregnant women

目的 探究乙型肝炎表面抗原(HBsAg)阳性孕妇外周血HBV-DNA含量、胎盘组织Toll样受体(TLR)3、TLR4表达与HBV宫内感染关系。方法 选取2018年4月-2021年4月河南省中医院122例外周血HBsAg阳性孕妇,根据是否发生HBV宫内感染,分为感染组34例和非感染组88例,比较不同乙型肝炎血清标记物类型、不同血HBV-DNA含量孕妇宫内感染率;比较感染组与非感染组胎盘组织TLR3、TLR4蛋白表达阳性率及平均光密度值;采用多因素Logistic回归探究HBsAg阳性孕妇HBV宫内感染影响因素。结果 不同乙型肝炎血清标记物类型孕妇宫内感染率比较,差异有统计学意义(P<0.05),HBsAg+HBeAg+HBcAb阳性发生率高于HBsAg+HBeAb+HBcAb阳性、HBsAg+HBcAb阳性及单纯HBsAg阳性(P<0.05);不同血HBV-DNA含量孕妇宫内感染率比较,差异有统计学意义(P<0.05),当HBV-DNA含量≥10~5 copy/ml时,宫内感染率升高(P<0.05);感染组胎盘组织TLR3、TLR4阳性例数低于非感染组(P<0.05),TLR3、TLR4平均光密度值低于非感染组(P<0.05)。多因素Logistic回归分析,HBeAg阳性、血HBV-DNA含量≥10~5 copy/ml是HBsAg阳性孕妇HBV宫内感染的危险因素(P<0.05),胎盘组织TLR3、TLR4表达阳性是其保护因素(P<0.05)。结论 HBsAg阳性孕妇血HBV-DNA含量、胎盘组织TLR3、TLR4表达与宫内感染发生有关,其中HBV-DNA含量≥10~5 copy/ml可能为宫内感染的含量界值,而胎盘组织TLR3、TLR4可能参与病毒感染相关过程。

OBJECTIVE To observe the relationship between blood HBV-DNA content, expression of Toll-like receptor 3(TLR3) and TLR4 in placental tissues and intrauterine HBV infection in hepatitis B surface antigen(HBsAg)-positive pregnant women. METHODS A total of 122 HBsAg-positive pregnant women who were treated in Henan Provincial Hospital of Traditional Chinese Medicine from Apr 2018 to Apr 2021 were enrolled in the study and divided into the infection group with 34 cases and the no infection group with 88 cases according to the status of intrauterine HBV infection. The incidence of intrauterine infection was compared among the pregnant women with different types of serum markers for hepatitis B and among the pregnant women with different contents of HBV-DNA, the positive rates of TLR3 and TLR4 in placental tissues and average optical density value were compared between the infection group and the no infection group, and multivariate logistic regression analysis was performed for the influencing factors for the intrauterine HBV infection in the HBsAg-positive pregnant women. RESULTS There was significant difference in the incidence of intrauterine infection among the pregnant women with different serum markers for hepatitis B(P<0.05), the incidence of intrauterine infection of the HBsAg+HBeAg+HBcAb pregnant women was significantly higher than that of the HBsAg+HBeAb+HBcAb pregnant women, the HBsAg+HBcAb pregnant women and the single HBsAg-positive pregnant women(P<0.05). There was significant difference in the incidence of intrauterine infection among the pregnant women with different contents of blood HBV-DNA(P<0.05), the incidence of intrauterine infection was increased significantly when the HBV-DNA contents was no less than 10~5 copy/ml(P<0.05). The number of placental tissue TLR3-, TLR4-positive cases was significantly less in the infection group than in the no infection group(P<0.05), the average optical density values of TLR3 and TLR4 of the infection group were significantly lower than those of the no infection group(P<0.05). Multivariate logistic regression analysis showed that the HBeAg(+) and blood HBV-DNA content no less than 105 copy/ml were the risk factors for intrauterine HBV infection in the HBsAg-positive pregnant women(P<0.05), while the positive expression of TLR3 and TLR4 in placental tissues was the protective factor(P<0.05). CONCLUSION The blood HBV-DNA content and expression of TLR3 and TLR4 in placental tissues are associated with the intrauterine infection in the HBsAg-positive pregnant women, the HBV-DNA content no less than 10~5 copy/ml might be the critical value for the intrauterine infection, while the placental TLR3 and TLR4 may be involved in the process of viral infection.