CAJ | 학술논문

目的：探讨在当前联合免疫方案下，发生乙肝母婴传播免疫预防失败过程中乙型肝炎病毒（ HBV） S基因的突变特征。方法：选择15例分娩免疫失败婴儿的孕妇及其联合免疫前的新生儿和免疫后的7月龄婴儿，将母亲、新生儿和婴儿分别配对，对其外周血中HBV的S基因（包括前 S和S）分2个片段进行PCR扩增测序，对比母亲、新生儿及婴儿3组间HBV基因型、前S和S基因突变率及突变位点的不同。结果：（1）新生儿和婴儿体内HBV的基因型与母亲完全相同。（2）3组2个片段的突变率差异均无统计学意义（P＞0．05）；同源树簇集分析中，母亲与所分娩的新生儿和婴儿体内HBV均形成各自独立的簇集。（3）突变位点：母亲-新生儿（13对）：7例新生儿与母亲体内的HBV存在不同的突变位点（共15个位点）；新生儿-婴儿（13对）：3例婴儿与新生儿体内的HBV存在不同的突变位点，即nt273A→A/G、nt512C→C/T和nt1139C→A（共3个位点），前2个位于S区的“a”决定簇之外，后1个则在与X编码框重叠的区域；婴儿-母亲（15对）：有9例婴儿与母亲体内的HBV存在不同的突变位点（共25个位点），但仅1例是母亲、新生儿和免疫后婴儿均存在不同的突变位点。结论：（1）新生儿及免疫后婴儿体内的HBV均源自于母亲；（2）HBV的S基因在联合免疫前和免疫后均可发生突变，主要发生在联合免疫前，是否与免疫失败有关尚需进一步研究。
목적：탐토재당전연합면역방안하，발생을간모영전파면역예방실패과정중을형간염병독（ HBV） S기인적돌변특정。방법：선택15례분면면역실패영인적잉부급기연합면역전적신생인화면역후적7월령영인，장모친、신생인화영인분별배대，대기외주혈중HBV적S기인（포괄전 S화S）분2개편단진행PCR확증측서，대비모친、신생인급영인3조간HBV기인형、전S화S기인돌변솔급돌변위점적불동。결과：（1）신생인화영인체내HBV적기인형여모친완전상동。（2）3조2개편단적돌변솔차이균무통계학의의（P＞0．05）；동원수족집분석중，모친여소분면적신생인화영인체내HBV균형성각자독립적족집。（3）돌변위점：모친-신생인（13대）：7례신생인여모친체내적HBV존재불동적돌변위점（공15개위점）；신생인-영인（13대）：3례영인여신생인체내적HBV존재불동적돌변위점，즉nt273A→A/G、nt512C→C/T화nt1139C→A（공3개위점），전2개위우S구적“a”결정족지외，후1개칙재여X편마광중첩적구역；영인-모친（15대）：유9례영인여모친체내적HBV존재불동적돌변위점（공25개위점），단부1례시모친、신생인화면역후영인균존재불동적돌변위점。결론：（1）신생인급면역후영인체내적HBV균원자우모친；（2）HBV적S기인재연합면역전화면역후균가발생돌변，주요발생재연합면역전，시부여면역실패유관상수진일보연구。
AIM:To explore the characteristics of hepatitis B virus S gene mutation in the vertical transmission after active and passive vaccination .METHODS:Fifteen cases of immunoprophylaxis failure were enrolled in the study . HBV S gene (including pres-S and S) from the mothers, newborns before active and passive vaccination and 7-month-old infants with immunoprophylaxis failure were detected by PCR amplification .The characteristics of HBV S gene mutation were compared among the 3 groups.RESULTS: The genotype of HBV in the newborns and the infants was the same as that in the mothers .The frequencies of mutation in the 2 fragments of the HBV S gene had no significant difference between the 3 groups.The homology tree model based on HBV S gene was analyzed in the 3 groups, in which every group had their own cluster.There were 15 different mutation sites between 7 pairs of mothers and newborns .There were 3 different muta-tion sites between 3 pairs of newborns and infants (nt273A→A/G, nt512C→C/T and nt1139C→A), among which the first 2 were located in the S gene region but not in the “a” determinant , and the latter was located in the overlap region of S and X genes .There were 25 different mutation sites between 9 pairs of mothers and infants , but only 1 case had a differ-ent mutation site between the mother , newborn and infant .CONCLUSION: The HBV species in newborns and infants with immunoprophylaxis failure were transmitted from the mothers .The mutations in the HBV S gene with immunoprophy-laxis failure happened before and after active and passive vaccination , mainly before vaccination .The relationship between HBV S gene mutations and immunoprophylaxis failure should be further explored .