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ＨＢＶＤＮＡ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ＨＢＶＤＮＡ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。
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 firsttrimester 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 insitu hybridization. Results The HBV infection rates of placentas from firsttrimester, secondtrimester to term periods were 4.2%(1/24), 1/6, and 44.6%(45/101), respectively. In one induced aborted fetal liver tissue (19week 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=2.83152.78). Conclusions HBV infection of placental capillary endothelial cell is a major risk factor of intrauterine transmission. HBV transplacental transmission route may be placental cell to cell transfer. The intrauterine infection may occur as early as on the 19th week of pregnancy, but the main timing is possibly in the thirdtrimester of pregnancy.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
1999年第7期392-395,共4页
Chinese Journal of Obstetrics and Gynecology
基金
国家自然科学基金
关键词
乙型肝炎
疾病传播
胎盘
宫内传播
Hepatitis BDisease transmission, verticalPlacenta
