乙肝病毒携带产妇感染状态与新生儿母婴传播的相关性研究

发布时间：2018-05-23 07:32

本文选题：乙型 + 肝炎　；参考：《安徽医科大学》2014年硕士论文

【摘要】：研究背景与目的全球几乎有近一半的人生活在HBV的高流行区，世界上有约三分之一的人口具有HBV感染的证据，25%-40%最后死于肝硬化和肝癌。我国是HBV感染的高发区，母婴传播是我国乙肝高发的一个重要因素,也是慢性乙型肝炎感染的主要原因,若不采取任何措施，HBV垂直传播的危险性甚至高达90%，乙肝病毒的母婴阻断始终是世界各国极为重视的问题。因此，本文对部分乙肝病毒携带孕妇的血液、乳汁和唾液的HBV和HBV-DNA载量进行了检测，探讨母体HBV感染状态和HBV-DNA载荷与婴儿垂直传播的关系。本文按照孕妇乙肝两对半检测结果和DNA拷贝进行分组，分别追踪观察其婴儿出生时的的HBV感染情况，旨在为HBV垂直传播阻断和预防提供理论和实验依据。方法将115例乙肝表面抗原(HBsAg)阳性的孕妇分为4组：第一组，，乙肝表面抗原（HBsAg）,乙肝e抗原（HBeAg）,乙肝核心抗体（HBcAb）阳性组；第二组，乙肝乙肝表面抗原（HBsAg）,乙肝e抗体(HBeAb）,乙肝核心抗体(HBcAb)阳性组；第三组，乙肝表面抗原（HBsAg）,乙肝核心抗体(HBcAb)阳性组；第四组，乙肝表面抗原（HBsAg）,乙肝e抗原（HBeAg）阳性组,对上述孕妇血液、乳汁和唾液进行乙肝表面抗原（HBsAg）、乙肝表面抗体（HBsAb）、乙肝e抗原（HBeAg）、乙肝e抗体（HBeAb）、乙肝核心抗体（HBcAb）及HBV病毒载量（HBV-DNA值）进行检测,对孕妇所生的新生儿在出生后24小时内进行乙肝表面抗原（HBsAg）、乙肝表面抗体（HBsAb）、乙肝e抗原（HBeAg）、乙肝e抗体（HBeAb）、乙肝核心抗体（HBcAb）的检测。结果乙肝HBsAg, HBeAg, HBcAb阳性（大三阳）和乙肝HBsAg, HBeAb, HBcAb阳性（小三阳）孕妇对新生儿垂直传播几率无显著差异（P0.05）；与小三阳相比大三阳孕妇乳汁中携带乙肝病毒的负荷较高(P0.05)，而两组孕妇唾液中携带乙肝病毒未见显著差异(P0.05)。孕妇乙肝HBsAg, HBeAg, HBcAb阳性（大三阳）孕妇血液HBV-DNA拷贝明显高于乙肝HBsAg, HBeAb, HBcAb阳性（小三阳）孕妇,大三阳孕妇新生儿发生宫内感染者14.3%。孕妇体内HBV-DNA值105基因拷贝/ml时发生新生儿宫内感染明显高于体内HBV-DNA值105基因拷贝/毫升（P0.01）。结论孕妇携带乙肝大三阳和乙肝小三阳都可对新生儿产生宫内感染的威胁，但乙肝大三阳孕妇或体内HBV-DNA载量高是新生儿宫内感染的重要危险因素,在新生儿宫内感染中占比较大的比例，应及时给予阻断,本研究结果提示，产后及时采取联合免疫措施，减少乙肝患儿的发生。 HBsAg阳性的孕妇，其乳汁中携带HBsAg有显著性差异，而唾液中携带HBsAg没有区别的，大三阳孕妇同时HBV-DNA载量高时须谨慎母乳喂养，小三阳孕妇哺乳时要检测HBV-DNA载量，以防止经乳汁的传播。
[Abstract]:Research background and purpose Nearly half of the world's population lives in highly endemic areas of HBV, and about 1/3 of the world's population has evidence of HBV infection-25 to 40 percent of the world's last deaths from liver cirrhosis and liver cancer. China is a high incidence area of HBV infection. Mother-to-child transmission is an important factor in the high incidence of hepatitis B in China, and it is also the main cause of chronic hepatitis B infection. If we do not take any measures to prevent the vertical transmission of HBV, the risk of HBV vertical transmission is even as high as 90%, the blocking of mother and child of hepatitis B virus has always been a serious problem all over the world. Therefore, the HBV and HBV-DNA loads in blood, milk and saliva of some pregnant women with HBV were detected, and the relationship between maternal HBV infection status, HBV-DNA load and vertical transmission of infants was discussed. In order to provide theoretical and experimental evidences for blocking vertical transmission of HBV and preventing HBV infection in infants, this paper divided them into two groups according to the results of two pairs of semi-detection and DNA copies of hepatitis B in pregnant women, and observed the infantile HBV infection in their infants. Method 115 pregnant women with hepatitis B surface antigen (HBsAg) positive were divided into four groups: the first group was HBsAg positive group, the second group was HBcAbpositive group. Hepatitis B surface antigen (HBsAg), hepatitis B e antibody (HBeAb), hepatitis B core antibody (HBcAb) positive group; group III, hepatitis B surface antigen HBsAg (HBsAg), hepatitis B core antibody (HBcAb) positive group; group IV, hepatitis B surface antigen HBsAg (HBsAg), hepatitis E antigen (HBeAg) positive group, for the blood of the pregnant women mentioned above, Milk and saliva were tested for HBsAg, HBV-DNA, HBV-DNA, HBV-DNA, HBV-DNA, HBeAg, HBeAg, HBeAb, HBcAband HBV-DNA, HBV-DNA, HBV-DNA, HBV-DNA, HBV-DNA, HBV-DNA, HBV-DNA, HBV-DNA, HBV-DNA, HBV-DNA, HBV-DNA, HBV-DNA, HBV-DNA, HBV-DNA and HBV-DNA. Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAg), hepatitis E antigen (HBeAg), hepatitis B e antibody (HBeAb), hepatitis B core antibody (HBcAb) were detected within 24 hours after birth. Result There was no significant difference in the probability of perpendicular transmission between the pregnant women with hepatitis B HBsAg, HBeAg, HBcAb positive (Big three positive) and hepatitis B HBsAg, HBeAb, HBcAb positive (small three positive) (P 0.05), and the pregnant women with hepatitis B virus had a higher burden of carrying hepatitis B virus in milk compared with the small three positive women (P 0.05), but there was no significant difference in the rate of perpendicular transmission between the pregnant women and the small three positive pregnant women. There was no significant difference between the two groups in carrying HBV in saliva. The blood HBV-DNA copy of pregnant women with HBsAg, HBeAg, HBcAb positive hepatitis B (positive third positive group) was significantly higher than that with hepatitis B HBsAg, HBeAb, HBcAb positive (small three positive group). The incidence of intrauterine infection in neonates with HBV-DNA 105 gene copy / ml in pregnant women was significantly higher than that in pregnant women with HBV-DNA 105 gene copy / ml (P0.01). Conclusion Pregnant women with hepatitis B positive third positive and small hepatitis B three positive could threaten their newborns with intrauterine infection. However, high HBV-DNA load in pregnant women or in their bodies is an important risk factor for intrauterine infection of newborns. The results of this study suggest that the combined immunological measures should be taken promptly to reduce the incidence of hepatitis B. The pregnant women with HBsAg positive had significant difference in carrying HBsAg in milk, but there was no difference in carrying HBsAg in saliva. Pregnant women with high HBV-DNA load should be carefully breast-fed, while pregnant women with small three yang should be tested for HBV-DNA load when breast-feeding. To prevent the spread of milk.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.251

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