乙型肝炎病毒%乙型肝炎%传染性疾病传播,垂直%乙型肝炎核心抗原%生物学标记%胎血
乙型肝炎病毒%乙型肝炎%傳染性疾病傳播,垂直%乙型肝炎覈心抗原%生物學標記%胎血
을형간염병독%을형간염%전염성질병전파,수직%을형간염핵심항원%생물학표기%태혈
Hepatitis B virus%Hepatitis B%Infectious disease transmission,vertical%Hepatitis B core antigens%Biological markers%Fetal blood
目的 探讨脐血乙型肝炎病毒(hepatitis B virus,HBV)血清学标记物在诊断HBV宫内感染中的应用价值. 方法 2011年10月8日至201 3年5月31日,在南京大学医学院附属鼓楼医院、江苏省泰兴市人民医院和镇江市妇幼保健院分娩的孕妇中,纳入278例乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)阳性、妊娠期未接受抗病毒治疗、无丙型肝炎病毒或人类免疫缺陷病毒感染的孕妇(其中3例双胎).281例新生儿生后12h内均进行被动免疫及主动免疫.孕妇分娩后立即采集脐血,分娩后2d内采集外周血,婴儿7～12月龄随访时采集外周血.采用荧光定量聚合酶链反应技术检测血清HBV DNA,检测下限为102 U/ml.采用酶联免疫吸附试验定性检测HBsAg、乙型肝炎表面抗体(hepatitis B surface antibody,抗-HBs)、乙型肝炎e抗原(hepatitis B e antigen,HBeAg)、乙型肝炎e抗体(hepatitis B e antibody,抗HBe)和乙型肝炎核心抗体(hepatitis B core antibody,抗HBc),以及抗HBc IgM.分析7～12月龄时的婴儿随访率,母血、脐血及婴儿的HBV血清标记物水平,婴儿慢性HBV感染率,以及脐血HBVDNA、抗-HBc IgM水平与HBV宫内感染的关系. 结果 7～12月龄时婴儿随访率为76.2％(214/281).71例HBeAg阴性孕妇分娩新生儿71例,其中8例(11.3％,8/71)脐血 HBV DNA阳性;随访到56例,其中7例(12.5％,7/56)脐血HBV DNA阳性,但7～12月龄时,54例(96.4％,54/56)抗-HBs阳性,HBsAg和抗-HBc均为阴性,无一例HBV感染.207例HBeAg阳性孕妇分娩新生儿210例,其中86例(41.0％,86/210)HBV DNA阳性;随访到1 58例,其中38例(24.1％,38/158)脐血HBV DNA和HBsAg同时阳性;但7～12月龄时仅6例(3.8％,6/158) HBsAg、HBeAg和抗-HBc同时阳性,HBV DNA为1.55×107～1.51×109 U/ml,诊断慢性HBV感染.脐血HBV DNA≥105 U/ml者中随访到7例,其中4例7～12月龄时未感染且有保护力;3例确诊HBV感染.另外3例HBV感染婴儿的脐血HBV DNA,1例为9.18×103 U/ml,2例低于检测下限.281例脐血标本的抗-HBc IgM均阴性. 结论 脐血HBV DNA阳性不能诊断HBV宫内感染,HBV DNA阴性不能排除HBV母婴传播;脐血抗-HBc IgM阳性率极低,阴性不能排除HBV宫内感染.
目的 探討臍血乙型肝炎病毒(hepatitis B virus,HBV)血清學標記物在診斷HBV宮內感染中的應用價值. 方法 2011年10月8日至201 3年5月31日,在南京大學醫學院附屬鼓樓醫院、江囌省泰興市人民醫院和鎮江市婦幼保健院分娩的孕婦中,納入278例乙型肝炎錶麵抗原(hepatitis B surface antigen,HBsAg)暘性、妊娠期未接受抗病毒治療、無丙型肝炎病毒或人類免疫缺陷病毒感染的孕婦(其中3例雙胎).281例新生兒生後12h內均進行被動免疫及主動免疫.孕婦分娩後立即採集臍血,分娩後2d內採集外週血,嬰兒7～12月齡隨訪時採集外週血.採用熒光定量聚閤酶鏈反應技術檢測血清HBV DNA,檢測下限為102 U/ml.採用酶聯免疫吸附試驗定性檢測HBsAg、乙型肝炎錶麵抗體(hepatitis B surface antibody,抗-HBs)、乙型肝炎e抗原(hepatitis B e antigen,HBeAg)、乙型肝炎e抗體(hepatitis B e antibody,抗HBe)和乙型肝炎覈心抗體(hepatitis B core antibody,抗HBc),以及抗HBc IgM.分析7～12月齡時的嬰兒隨訪率,母血、臍血及嬰兒的HBV血清標記物水平,嬰兒慢性HBV感染率,以及臍血HBVDNA、抗-HBc IgM水平與HBV宮內感染的關繫. 結果 7～12月齡時嬰兒隨訪率為76.2％(214/281).71例HBeAg陰性孕婦分娩新生兒71例,其中8例(11.3％,8/71)臍血 HBV DNA暘性;隨訪到56例,其中7例(12.5％,7/56)臍血HBV DNA暘性,但7～12月齡時,54例(96.4％,54/56)抗-HBs暘性,HBsAg和抗-HBc均為陰性,無一例HBV感染.207例HBeAg暘性孕婦分娩新生兒210例,其中86例(41.0％,86/210)HBV DNA暘性;隨訪到1 58例,其中38例(24.1％,38/158)臍血HBV DNA和HBsAg同時暘性;但7～12月齡時僅6例(3.8％,6/158) HBsAg、HBeAg和抗-HBc同時暘性,HBV DNA為1.55×107～1.51×109 U/ml,診斷慢性HBV感染.臍血HBV DNA≥105 U/ml者中隨訪到7例,其中4例7～12月齡時未感染且有保護力;3例確診HBV感染.另外3例HBV感染嬰兒的臍血HBV DNA,1例為9.18×103 U/ml,2例低于檢測下限.281例臍血標本的抗-HBc IgM均陰性. 結論 臍血HBV DNA暘性不能診斷HBV宮內感染,HBV DNA陰性不能排除HBV母嬰傳播;臍血抗-HBc IgM暘性率極低,陰性不能排除HBV宮內感染.
목적 탐토제혈을형간염병독(hepatitis B virus,HBV)혈청학표기물재진단HBV궁내감염중적응용개치. 방법 2011년10월8일지201 3년5월31일,재남경대학의학원부속고루의원、강소성태흥시인민의원화진강시부유보건원분면적잉부중,납입278례을형간염표면항원(hepatitis B surface antigen,HBsAg)양성、임신기미접수항병독치료、무병형간염병독혹인류면역결함병독감염적잉부(기중3례쌍태).281례신생인생후12h내균진행피동면역급주동면역.잉부분면후립즉채집제혈,분면후2d내채집외주혈,영인7～12월령수방시채집외주혈.채용형광정량취합매련반응기술검측혈청HBV DNA,검측하한위102 U/ml.채용매련면역흡부시험정성검측HBsAg、을형간염표면항체(hepatitis B surface antibody,항-HBs)、을형간염e항원(hepatitis B e antigen,HBeAg)、을형간염e항체(hepatitis B e antibody,항HBe)화을형간염핵심항체(hepatitis B core antibody,항HBc),이급항HBc IgM.분석7～12월령시적영인수방솔,모혈、제혈급영인적HBV혈청표기물수평,영인만성HBV감염솔,이급제혈HBVDNA、항-HBc IgM수평여HBV궁내감염적관계. 결과 7～12월령시영인수방솔위76.2％(214/281).71례HBeAg음성잉부분면신생인71례,기중8례(11.3％,8/71)제혈 HBV DNA양성;수방도56례,기중7례(12.5％,7/56)제혈HBV DNA양성,단7～12월령시,54례(96.4％,54/56)항-HBs양성,HBsAg화항-HBc균위음성,무일례HBV감염.207례HBeAg양성잉부분면신생인210례,기중86례(41.0％,86/210)HBV DNA양성;수방도1 58례,기중38례(24.1％,38/158)제혈HBV DNA화HBsAg동시양성;단7～12월령시부6례(3.8％,6/158) HBsAg、HBeAg화항-HBc동시양성,HBV DNA위1.55×107～1.51×109 U/ml,진단만성HBV감염.제혈HBV DNA≥105 U/ml자중수방도7례,기중4례7～12월령시미감염차유보호력;3례학진HBV감염.령외3례HBV감염영인적제혈HBV DNA,1례위9.18×103 U/ml,2례저우검측하한.281례제혈표본적항-HBc IgM균음성. 결론 제혈HBV DNA양성불능진단HBV궁내감염,HBV DNA음성불능배제HBV모영전파;제혈항-HBc IgM양성솔겁저,음성불능배제HBV궁내감염.
Objective To investigate the role of hepatitis B virus (HBV) DNA and hepatitis B core antibody (anti-HBc) IgM in cord blood for diagnosis of HBV intrauterine infection.Methods From October 8, 2011 to May 31, 2013, a total of 278 pregnant women with positive hepatitis B surface antigen (HBsAg) were enrolled from Nanjing Drum Tower Hospital, Taixing People's Hospital, and Zhenjiang Metarnal and Child Hospital.None of them had received antiviral therapy, co-infection with hepatitis C virus or human immunodeficiency virus.All 281 newborns (three pairs of twins) of them had been vaccinated against hepatitis B and received hepatitis B immunoglobulin (HBIG) within 12 h after birth.Serum samples of HBsAg-positive women at 2 days after delivery and cord sera of their neonates as well as sera of these children followed up at the age of 7-12 months were collected.HBV DNA levels were detected by fluorescent quantitative polymerase chain reaction, with the lower detection limit of 102 U/ml.HBV serologic markers and anti-HBc IgM were examined by enzyme linked immunosorbent assay.HBsAg and hepatitis B e antigen (HBeAg) were quantified with Abbott reagents.Then we analyzed the rate of infants followed-up, the level of HBV markers, and the relationship of HBV DNA, anti-HBc IgM and HBV intrauterine infection.Results Totally 214 (76.2％) infants were followed up at the age of 7 12 months.Of the 71 cord blood samples of HBeAg-negative mothers, eight (11.3％) had detectable HBV DNA;among the 56 followed-up infants, seven (9.9％) were positive for HBV DNA, while 54 were positive for anti-HBs and negative for both HBsAg and anti-HBc.None of the above 56 infants were positive for HBsAg, HBeAg, or anti-HBc.Of the 210 cord blood samples of the 207 HBeAg-positive mothers, 86 (41.0％) had detectable HBV DNA.Of the 158 infants who attended the follow-up, 38 (24.1％, 38/158) were positive for both HBV DNA and HBsAg, while only six (3.8％, 6/158) were positive for HBsAg, HBeAg, and anti-HBc.Chronic HBV infection was diagnosed when levels of HBV DNA ranged from 1.55 × 107 to 1.51 × 109 U/ml.Seven infants with HBV DNA ≥ 105 U/ml in cord blood were followed up, and only three confirmed to be HBV infection.The other four cases were not infected and effectively protected.Of the three infected infants,one showed 9.18 × 103 U/ml HBV DNA level in cord blood, and the remaining two were below 102 U/ml.AntiHBc IgM was negative in all 281 cord blood.Conclusions The intrauterine infection can not be determined by high level of HBV DNA in cord blood, nor be ruled out by undetectability of HBV DNA.The positive rate of anti-HBc IgM in cord blood is extremely low, indicating the useless of anti-HBc IgM in cord blood to define intrauterine infection.
