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目的了解乙型肝炎免疫球蛋白(HBIG)在阻断母婴传播过程中S基因变异的特点,比较与未予阻断者的差异,探讨基因变异与宫内传播的关系,协助评价HBIG的治疗安全性。方法将18对乙型肝炎病毒(HBV)携带母亲及其宫内感染新生儿按母亲产前处理分为HBIG组8对,母亲于产前3月起肌肉注射HBIG 200-400 IU至分娩前;对照组10对,母亲产前不接受HBIG者。巢式PCR扩增HBV S基因片段并直接测序。以每对病例第一份(母亲孕中期)血清HBV株S基因区氨基酸(或核苷酸)作为标准,对每对病例第二份血清(母亲分娩前)和第三份血清(新生儿)HBV株进行分析。结果HBV S区碱基替代突变率和氨基酸变异数在HBIG组和对照组之间的差异均无统计学意义;18例宫内感染儿17例其病毒株与母亲分娩前的优势株一致,其中4例为S区变异株;18例宫内感染儿病毒株分型B型adw2 12例,C型adrq+6例。结论无症状携带HBV孕妇产前使用现有剂量HBIG至临产并未增加HBV S区的变异。HBV S区变异株和未变异株均可经宫内传播,宫内感染发生于孕后期;HBV S区变异并非发生宫内感染的主要原因。
Objective To investigate the characteristics of hepatitis B immunoglobulin (HBIG) in the gene mutation during the mother-to-child transmission, compare the differences with those of non-occlusion patients, explore the relationship between gene mutation and intrauterine transmission, and evaluate the treatment of HBIG safety. Methods Eighty pairs of HBV-infected mothers and their newborns infected with intrauterine infection were divided into 8 groups according to their mother’s prenatal treatment. The mother injected intramuscular HBIG 200-400 IU from prenatal month 3 to before delivery. The control group of 10 pairs, the mother did not accept HBIG prenatal. The HBV S gene fragment was amplified by nested PCR and sequenced directly. The second serum (prenatal delivery) and the third serum (newborn) in each case were calculated using the amino acid (or nucleotide) of the S gene region in the first HBV (HBV) HBV strain for analysis. Results There was no significant difference in mutation rate of base substitution and amino acid in HBV S region between HBIG group and control group. Among the 18 cases with intrauterine infection, 17 cases were consistent with the predominant strains before delivery 4 cases were S region mutant strains; 18 cases of intrauterine infection virus strains were type B adw2 12 cases, C type adrq + 6 cases. Conclusions Asymptomatic carriers of HBV in pregnant women prenatal use of the existing dose of HBIG to labor did not increase the variation of HBV S region. HBV S mutation and unvarying strains can be transmitted intrauterine infection, intrauterine infection occurred in the second trimester; HBV S mutation is not the main cause of intrauterine infection.