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目的探讨较敏感的筛查乙型肝炎病毒(HBV)宫内传播的监测方法和指标,并评价其临床应用价值。方法应用荧光定量聚合酶链反应和酶联免疫吸附试验检测142例HBsAg阳性孕妇血清及其新生儿脐带血的HBV-DNA和乙肝血清学标志物。结果新生儿脐带血的HBV-DNA阳性率为16.2%(23/142),高于脐带血HBsAg的阳性率9.8%(14/142)(P<0.01);血清HBeAg阳性孕妇其新生儿脐带血HBV-DNA阳性率为41.0%(16/39),高于HBeAg阴性孕妇组的阳性率6.8%(7/103)(P<0.001),新生儿脐带血的HBV-DNA阳性率随孕妇HBV-DNA含量增加而增加(P<0.01)。结论应用荧光定量聚合酶链反应检测新生儿脐带血HBV-DNA是监测乙型肝炎发生宫内传播的较敏感指标;孕妇血清HBV-DNA高含量是乙型肝炎宫内感染的高危因素。
Objective To explore a more sensitive monitoring method and index of intrauterine transmission of Hepatitis B virus (HBV) and evaluate its clinical value. Methods Serum HBV-DNA and hepatitis B serological markers were detected in serum of 142 HBsAg-positive pregnant women and their neonates by fluorescence quantitative polymerase chain reaction and enzyme-linked immunosorbent assay. Results The positive rate of HBV-DNA in neonatal umbilical cord blood was 16.2% (23/142), higher than that of cord blood HBsAg (9.8%, 14/142) (P <0.01). Serum HBeAg positive pregnant women had neonatal umbilical cord blood The positive rate of HBV-DNA was 41.0% (16/39), higher than that of HBeAg-negative pregnant women (6.8%, 7/103) (P <0.001). The positive rate of HBV- DNA content increased (P <0.01). Conclusion Detecting neonatal umbilical cord blood HBV-DNA by fluorescence quantitative polymerase chain reaction is a sensitive indicator to monitor the intrauterine transmission of hepatitis B. The high serum HBV-DNA level in pregnant women is a high risk factor for intrauterine infection.