大理州白族HBV阳性孕妇脐血病毒基因型分析及母婴传播相关问题的研究

发布时间：2018-03-03 11:33

  本文选题：大理白族　切入点：HBV　出处：《大理学院》2014年硕士论文　论文类型：学位论文

【摘要】：研究背景：慢性乙型肝炎是一种病毒性感染，是目前世界范围内严重的公共卫生问题之一，给社会及家庭的健康带来了严重的影响。目前全球范围内乙型肝炎病毒（HBV）慢性感染者已经达到甚至超过了3.5亿【1,2】，而1/3以上已经出现严重的肝脏疾病，每年约100万人【3】死于乙型肝炎病毒感染相关的疾病，包括【4】慢性肝炎、肝纤维化、肝硬化和肝细胞癌。我国是HBV的高分布区，人群携带病毒率呈逐渐增加的趋势，与乙型肝炎病毒感染相关的疾病也逐渐增多且病情复杂化。但总的来说，这些疾病的发展与演变均与乙型肝炎表面抗原（HBsAg）持续存在密不可分。故研究清除HBsAg的途径尤为重要。研究发现，乙肝的发病率在全球不同的地方差异较大。这些差异主要与疾病的感染途径及病毒的相关性状有一定的关系。在乙肝的传播途径中，母婴传播被认为是最主要的传播途径，且胎儿及新生儿时期感染乙肝病毒后，大约90%【5】以上会转为慢性乙肝病毒携带者，病毒难以清除，成年后发展为肝硬化及肝癌的概率也将明显增多。故控制乙肝病毒的发展，降低人群中与乙肝病毒感染相关的疾病的发病率，主要在于探讨母婴间的传播。母婴间的传播主要是宫内传播，宫内传播与孕妇的感染状况及不同型别的病毒基因有关，同时孕妇孕期免疫状态、感染病毒模式、分娩方式等都将影响母婴传播。 目的：探讨大理州白族孕妇及新生儿感染的HBV基因分布、病毒携带状态与母婴传播的相关问题。 方法：本实验采集云南省大理白族自治州大理学院附属医院、大理市第一人民医院、大理市妇幼保健院2011年12月至2013年09月住院分娩HBV阳性白族孕妇血清及分娩的新生儿脐血，分别采集孕妇血清及新生儿脐血87例。首先采用ELISA检测标本乙肝两对半模式，再应用荧光PCR对符合标本进行基因型检测；对乙肝标志物阳性者行定量PCR检测HBV DNA含量。进行重复试验，实验数据用SPSS16.0软件进行统计学分析和处理，两组间率的比较采用卡方检验，均以α=0.05为检验水准，P 0.05有统计学意义。 结果：87份孕妇血清中，B基因型40例（45.98%），C基因型19例（21.84%），B+C基因型18例（20.69%），B+E基因型2例（2.30%），，未分型8例（9.20%）；41例HBeAg阳性者血清中HBV-DNA阳性为35例（85.37%），46例HBeAg阴性者血清中HBV-DNA阳性为12例（26.09%）；87例孕妇足月分娩87例新生儿中，乙肝表面标志物阳性者有48例；48例乙肝标志物阳性新生儿中，来自母HBeAg阳性者为35例，来自母HBeAg阴性者为13例；48例新生儿检测HBV DNA，其中阳性27例；48例新生儿行HBV基因分型，结果B基因型18例（37.50%），C基因型8例（16.67%），B+C基因型12例（25.00%），其余未分型10例（20.83%）；50例足月剖宫产儿中HBV-DNA阳性者18例（36%），37例足月顺产儿中HBV DNA阳性者9例（24%）。 结论：1大理白族孕妇感染HBV基因型主要是B型，其次是C型，存在少量的混合型基因型； 2HBV存在母婴间的传播，新生儿感染HBV后的基因型与孕妇一致，主要基因型是B型； 3大理白族孕妇感染HBV后，B基因型的孕妇发生HBV母婴传播的可能性较大； 4大理白族孕妇中，HBeAg阳性者更易检测出HBV DNA； 5大理白族孕妇HBeAg阳性者，更易发生母婴间的传播； 6分娩方式的选择并不改变大理白族孕妇及新生儿HBV母婴间的传播； 7研究孕妇的乙型肝炎病毒基因型为减少新生儿感染及预防严重肝脏疾病提供依据。
[Abstract]:Background: chronic hepatitis B is a viral infection, is one of the public health problems worldwide serious, has brought the serious influence to the society and family health. The scope of the current global chronic hepatitis B virus (HBV) infection has reached or even exceeded 350 million [1,2], which has been over 1/3 severe liver disease, about 1 million people per year [3] died of diseases related to hepatitis B virus infection [4], including liver fibrosis, chronic hepatitis, cirrhosis and hepatocellular carcinoma. China is the high distribution area of HBV, the crowd carry virus rate increased, associated with hepatitis B virus infection the disease has gradually increased and the condition is complicated. But in general, the development and evolution of these diseases are related to hepatitis B surface antigen (HBsAg) continue to exist are inseparable. So the study of the path is clear HBsAg To. The study found that the incidence of hepatitis B large local differences in the global different. There is a certain relationship between these differences and the main route of infection and virus disease. The route of hepatitis B transmission, mother to child transmission is considered the main route of transmission, and the fetal and neonatal period after infection of hepatitis B virus about 90%, [5] above will become chronic carriers of hepatitis B virus, the virus is difficult to remove, for adult probability of liver cirrhosis and hepatocellular carcinoma will be increased significantly. Therefore, the development of hepatitis B virus, reducing the population in hepatitis B virus infection and related disease incidence, investigates the mother to child transmission of the communication. Between mother and child is mainly intrauterine transmission, infection and intrauterine infection of pregnant women and different types of viral genes, and maternal immune status, infection mode, the mode of delivery will be affected Mother to child transmission.
Objective: To investigate the distribution of HBV gene in the infection of pregnant and newborn babies of Bai nationality in Dali, and the related problems of the virus carrying status and mother to child transmission.
Methods: This study collected in Yunnan Bai Autonomous Prefecture of Dali province Dali University Affiliated Hospital, Dali First People's Hospital, Dali maternal and child health hospital from December 2011 to 2013 09 months of hospital delivery and delivery serum HBV positive pregnant women Bai in umbilical cord blood, serum and umbilical cord blood of pregnant women were collected. 87 cases were first detected by ELISA were two semi hepatitis B model, then the application of fluorescence PCR according to the samples for genotyping; on HBV markers positive for quantitative detection of PCR HBV DNA. The content of repeated experiments, experimental data processing and statistical analysis was performed with the SPSS16.0 software, between the two groups was compared using the chi square test is to test the level of a =0.05, P 0.05 was statistically significant.
缁撴灉锛

本文编号：1560873