乙型肝炎病毒宫内感染相关因素的探讨

目的探讨孕妇乙型肝炎病毒感染状态及胎盘感染与宫内感染关系，进而分析乙型肝炎病毒宫内感染的危险因素。方法采用荧光定量PCR技术及酶联免疫吸附试验，对92例HBsAg阳性孕妇及其新生儿的外周血行HBV DNA及乙肝血清标志物检测。采用免疫组化S-P法，对92例HBsAg阳性孕妇分娩时胎盘组织行HBsAg及HBcAg的检测。结果（1）HBeAg阳性孕妇与HBeAg阴性孕妇HBV宫内感染率分别为21．2％（11／52）和0（0／40），差异有显著性（P〈0．01）；HBV DNA阳性孕妇与HBV DNA阴性孕妇HBV宫内感染率分别为18．64％（11／59）和0（0／33），差异有显著性（P〈0．025）。（2）92例HBsAg阳性孕妇的胎盘中共检测出43例HBsAg和（或）HBcAg阳性，阳性率由胎盘的母面至胎儿面有逐渐下降的趋势。由胎盘屏障的蜕膜细胞（DC）、滋养层细胞（TC）、绒毛间质细胞（VSC）和绒毛毛细血管内皮细胞（VCEC）感染而致的宫内传播的相对危险度比值比（0R）分别为4．53、7．15、9．33和24．33，0R值从胎盘的母面至胎儿面有逐渐上升的趋势。结论新生儿宫内感染与孕妇乙肝感染状态有关，HBV宫内感染以经胎盘感染为主，感染胎儿的途径可能是通过细胞转移方式实现的，胎盘屏障对胎儿有一定的保护作用。HBeAg阳性、HBV DNA阳性及绒毛毛细血管内皮细胞（VCEC）感染是新生儿宫内HBV感染的危险因素。

Study on Hepatitis B Virus Intrauterine Infection State and its Correlation Factors

Objective To investigate the relationship between Hepatitis B virus(HBV) infections status in pregnant women and Placenta infection to intrauterine fetal infection,and to study the risk factors for HBV intrauterine infection.Methods ELISA and PCR were used for detection of HBV infection markers of serums which were obtained from 92 HBsAg positive mothers and newborn infants of them.S-P immunohistochemical straining with monoclonal anti-HBs and anti-HBc antibodies were used for detection of placenta born of 92 HBsAg positive mothers.Results(1)The intrauterine infection rate among the infants of maternal HBeAg positive was significantly higher than that of maternal HBeAg negative(P<0.01);The newborn infants infection rate of HBV DNA positive maternal was significantly higher than that of maternal HBV DNA negative(P<0.025),(2)HBsAg and/or HBcAg were detected in 43 of 92 placentas of HBsAg positive mothers,The positive rates in decidual cell,Trophoblastic cell,villous stoma cell and villous capillary endothelial cell were gradually decreased of HBV infection from maternal side to fetal side of placenta.The ORs of HBV intrauterine infections due to infections of DC,TC,VSC and VCEC of placenta barrier were 4.53,7.15,9.33 and 24.33.respectively,There was a increasing trend of the ORs from maternal side to fetal side of placenta.Conclusion(1)The main route of HBV transmission from mother to fetus is transplacental,the transplacental transmission of HBV may be a cellular transfer,Placental barrier can offer conservancy effect on fetus to some extent.(2)The risk factors of HBV intrauterine infection are maternal HBeAg and HBV DNA positive and HBV infection of placental villous capillary endothelial cell.