HBV感染孕产妇宫内感染发生情况及与病毒载量关系

Situation of the neonatal intrauterine infection of pregnant women with hepatitis B virus infection and its correlation with the viral load

目的:探究乙型肝炎病毒(HBV)感染不同类型、HBV-DNA病毒载量孕产妇宫内感染发生情况,分析不同HBV-DNA病毒载量与细胞因子水平相关性。方法:选取本院2020年1月-2023年10月产前检查并足月分娩的乙型肝炎病毒表面抗原(HBsAg)阳性孕妇100例及其新生儿,统计新生儿HBV宫内感染情况,检测产妇HBV-DNA病毒载量水平,对比不同乙肝感染类型、HBV-DNA病毒载量孕产妇宫内感染发生率,不同HBV-DNA病毒载量孕产妇白介素-6(IL-6)、干扰素γ(IFN-γ)水平差异,Spearman相关系数分析HBV-DNA病毒载量与IL-6、IFN-γ的相关性。结果:100例孕产妇中HBsAg+HBeAg+HBcAb感染36例(36.0%)、HBsAg+HBeAb+HBcAb感染64例(64.0%);宫内感染发生率为25.0%,宫内感染发生率HBsAg+HBeAg+HBcAb孕产妇(22.2%)高于HBsAg+HBeAb+HBcAb孕产妇(3.1%)(P<0.05);HBV-DNA病毒载量阴性6例,10^(3)~10^(5)病毒载量62例、>105病毒载量32例,10^(3)~10^(5)病毒载量孕妇宫内感染发生率(4.8%)低于>10^(5)病毒载量孕妇(21.9%),IL-6水平(8.11±0.89pg/ml)低于>10^(5)病毒载量孕产妇(11.26±1.56pg/ml)且与HBV-DNA载量呈正相关,IFN-γ水平(68.47±7.10pg/L)高于>105病毒载量孕产妇(51.22±5.65pg/L)且与HBV-DNA载量呈负相关(均P<0.05)。结论:感染HBV孕产妇宫内感染发生风险升高,主要感染类型是HBsAg+HBeAb+HBcAb,但HBsAg+HBeAg+HBcAb型、HBV-DNA病毒载量高孕产妇宫内感染风险提高,HBV-DNA病毒载量增加宫内感染风险可能与调控Th1/Th2免疫失衡有关。

Objective:To explore the situations of the neonatal intrauterine infection of pregnant women with different types of hepatitis B virus(HBV)infection and with different HBV-DNA load,and to study the correlation between the women with different types of HBV infections and their cytokine levels.Methods:A total of 100pregnant women with HBV surface antigen(HBsAg)positive and their newborns who delivered at term after prenatal examination in hospital from January 2020to October 2023were selected in this study.The incidence of the neonatal intrauterine infection was calculated.The HBV viral load of the women was detected.The incidence of the neonatal intrauterine infection was compared among the women with different types of HBV infection and among the women with different HBV-DNA load.The differences of the interleukin-6(IL-6)and interferonγ(IFN-γ)levels were compared among the women with different HBV-DNA load.Spearman correlation coefficient was used to analyze the correlation between the HBV load of the pregnant women and their IL-6and IFN-γlevels.Results:Among 100pregnant women,there were 36(36.0%)cases with the positive HBsAg,HBeAg and HBcAb(in group A)and 64(64.0%)cases with the positive HBsAg,HBe-Ab and HBcAb(in group B).The incidence of the neonatal intrauterine infection(22.2%)of the women in group A was significantly higher than that(3.1%)of the women in group B(P<0.05).There were 6women with the negative HBV,62women with 10^(3)-10^(5)HBV load of and 32women with>10^(5)HBV load.The incidence of the neonatal intrauterine infection(4.8%)and the level of IL-6(8.11±0.89pg/ml)of the women with 10^(3)-10^(5)HBV load were significantly lower than those(21.9%and 11.26±1.56pg/ml)of the women with>105 HBV load.The IL-6level of the women was positively correlated with their HBV load.The level of IFN-γ(68.47±7.10pg/L)of the women with 10^(3)-10^(5)HBV load of was significantly higher than that(51.22±5.65pg/L)of the women with>105 HBV load,and which of the women was negatively correlated with their HBV load(all P<0.05).Conclusion:The risk of the neonatal intrauterine infection of the pregnant women with HBV infection increases.The type of the HBV infection of the pregnant women is mainly the positive HBsAg,HBeAb and HBcAb.The risk of the neonatal intrauterine infection of the pregnant women with the positive HBsAg,HBeAg and HBcAb or the women with high HBV load increases is high.The high HBV load of the pregnant women will increase their neonatal intrauterine infection rate,and which may be related to the regulation of Th1/Th2immune imbalance of the women.