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目的探讨乙型肝炎病毒(HBV)宫内感染的相关因素、新生儿外周血单个核细胞(PBMC)及胎盘HBV感染的影响因素。方法分别采用酶联免疫吸附试验,检测151例血清HBsAg阳性孕妇HBV标志物及其新生儿血清HBsAg;PCR检测孕妇及其新生儿血清和PBMC中的HBVDNA;免疫组化ABC法检测孕妇胎盘组织中HBsAg。非条件logistic回归模型对孕妇血清HBVDNA阳性、孕妇PBMCHBVDNA阳性、胎盘HBV感染等73项危险因素进行分析。结果(1)151例血清HBsAg阳性孕妇分娩的151例新生儿中,血清HBsAg阳性5例,血清HBVDNA阳性29例,PBMCHBVDNA阳性36例,HBV标志物任一项阳性57例,宫内感染率为37·8%(57/151)。(2)HBV宫内感染的危险因素为孕妇血清HBVDNA阳性、孕妇PBMCHBVDNA阳性、胎盘HBV感染比值比(OR)分别为2·25(1·08~4·72)、2·69(1·26~5·73)、4·63(1·70~12·62)。(3)胎盘HBV感染的危险因素为孕妇血清HBVDNA阳性,OR为4·24(1·22~14·69)。(4)新生儿PBMCHBVDNA阳性的危险因素为孕妇PBMCHBVDNA阳性,OR为24·53(7·92~76·01)。结论孕妇PBMC和血清HBVDNA阳性及胎盘HBV感染为HBV宫内感染的危险因素;孕妇PBMCHBVDNA阳性可能是形成新生儿宫内感染的独立危险因素。
Objective To investigate the related factors of hepatitis B virus (HBV) intrauterine infection, peripheral blood mononuclear cells (PBMC) in neonates and the influencing factors of placental HBV infection. Methods Serum HBsAg and HBsAg were detected by enzyme-linked immunosorbent assay (ELISA) in 151 pregnant women with positive HBsAg, HBVDNA in serum and PBMC of pregnant women and their newborns by PCR, ABC method of immunohistochemical ABC in placental tissue of pregnant women HBsAg. Non-conditional logistic regression model was used to analyze 73 risk factors such as positive serum HBVDNA, positive PBMCHBVDNA in pregnant women and HBV infection in placenta. Results (1) Serum HBsAg was positive in 151 cases of 151 newborns with serum HBsAg positive mothers. Serum HBsAg was positive in 29 cases, PBMCHBVDNA was positive in 36 cases, HBV markers were positive in any of 57 cases, intrauterine infection rate was 37.8% (57/151). (2) The risk factors of HBV intrauterine infection were positive serum HBVDNA in pregnant women, positive pregnant women PBMCHBVDNA, and placental HBV infection ratio (OR) were 2.25 (1.08 ~ 4.72), 2.69 ~ 5 · 73), 4.63 (1.70 ~ 12.62). (3) The risk factors of HBV infection in placenta are HBVDNA positive in pregnant women with an OR of 4.24 (ranged from 1.22 to 14.69). (4) The positive risk factors of PBMCHBVDNA in newborns were positive for PBMCHBVDNA in pregnant women, OR was 24.53 (ranged from 7.92 to 76.01). Conclusion The positive rate of PBMC and serum HBVDNA in pregnant women and HBV infection in placenta are the risk factors of HBV intrauterine infection. The positive of PBMCHBVDNA in pregnant women may be an independent risk factor for neonatal intrauterine infection.