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胎盘乙型肝炎病毒感染与宫内传播的关系 |
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闫永平 徐德忠 王文亮 刘斌 刘志华 门可 张景霞 徐剑秋
【摘要】 目的 探讨乙型肝炎病毒（HBV）宫内传播的危险因素, 并追踪HBV经胎盘传播的途径和胎儿宫内感染的时间。方法 共收集了乙型肝炎表面抗原(HBsAg)携带孕妇131例，其中孕早期人工流产胎盘24例、孕中期引产胎盘和胎儿各6例、足月分娩胎盘和新生儿各101例。孕妇和新生儿血清HBsAg 和HBV DNA检测分别采用酶联免疫吸附试验（ELISA）和聚合酶链反应（PCR）法。胎盘的HBsAg、HBxAg、HBcAg检测和HBV DNA检测分别采用ABC免疫组织化学染色法和原位杂交法。结果 孕早期、孕中期和足月分娩胎盘的HBV感染率分别为4.2% (1/24), 1/6, 和44.6% (45/101)。1例孕中期引产胎儿的肝脏中检测到HBV蛋白和DNA,其胎盘从母面到胎儿面各层细胞也均受染。101例新生儿中,8例（7.9%）发生了宫内感染。胎盘绒毛毛细血管内皮细胞的HBV感染发生宫内传播的相对危险度比值为18.46(95%可信限=2.83～152.78)。结论 胎盘绒毛毛细血管内皮细胞感染是宫内传播的主要危险因素。HBV经胎盘感染胎儿的途径可能是通过胎盘细胞至细胞的传递而实现的。宫内感染可发生在孕中期，但主要的发生时间是孕晚期。
【关键词】 肝炎，乙型 疾病传播，垂直 胎盘
The Role of Placenta in Hepatitis B Virus Intrauterine Transmission
YAN Yongping, XU Dezhong, WANG Wenliang, et al.
Fourth Military Medical University, Xi’an 710032
【Abstract】 Objectives To determine the role of placenta in hepatitis B virus (HBV) intrauterine transmission, and to trace the route of transplacental transmission and the timing of HBV infection in uterus. Methods We collected 101 term placentas and newborn infants, 24 aborted first-trimester placentas, and 6 induced aborted fetuses and placentas from 131 HBsAg carrying pregnant women. Serologic HBV markers (HBsAg and HBV DNA) of pregnant women and newborns were detected by ELISA and PCR. The HBsAg, HBxAg, HBcAg and HBV DNA in placentas were determined by ABC immunohistochemical staining and in-situ hybridization. Results The HBV infection rates of placentas from first-trimester, second-trimester to term periods were 4.2%(1/24), 1/6, and 44.6%(45/101), respectively. In one induced aborted fetal liver tissue (19-week of pregnancy), the proteins and DNA of HBV were detected, and its placental villous capillary endothelial cells were also infected. The OR of HBV infection of villous capillary endothelial cells in intrauterine transmission was 18.46(95% CI=2.83～152.78). Conclusions HBV infection of placental capillary endothelial cell is a major risk [1] [2] [3] 下一页
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