【摘要】 目的探讨HBV携带孕妇血清、乳汁HBV-DNA载量不同的状况下采用母乳喂养安全性及对母婴传播阻断效果的影响。方法应用荧光定量聚合酶链反应和酶免疫测定(EIA)技术对167例HBV携带孕妇血清、乳汁及婴儿24月龄血标本进行HBV-DNA定量和HBVM检测。婴儿分别采用母乳和人工两种喂养方式。对婴儿做3(T(Time)3)、9(T9)、12(T12)、24(T24)个月追踪检测观察,采取婴儿血标本应用Abbott放射免疫测定(RIA)试剂检测HBsAg、抗-HBs。结果HBsAg、HBeAg双阳性孕妇的血清、乳汁HBV-DNA阳性率为100%、49.45%,P<0.005,HBV-DNA平均含量(拷贝数/mL的对数)为(7.43±1.81)、(4.02±1.03);HBsAg单阳性孕妇的血清、乳汁HBV-DNA阳性率为77.63%、13.16%,P<0.001,HBV-DNA含量为(5.76±0.82)、(3.42±0.35);初乳HBV-DNA检出率随母血HBV-DNA载量的增加而增加;双阳性孕妇的婴儿,母乳喂养和人工喂养,HBV感染率为15.63%和13.56%,统计学分析χ2=0.028,P>0.05差异无显著性。单阳性孕妇的婴儿,母乳喂养和人工喂养,均未发生HBV感染。167例婴儿抗-HBs检测,母乳喂养组抗体几何平均滴度(GMT)明显高于人工喂养组;发生HBV-DNA感染的13例婴儿T24血标本HBV-DNA载量为(3.24±0.23)。结论HBV携带孕妇血清HBV-DNA载量大于109cps/mL的婴儿是母婴传播的高危易感人群;HBV感染婴儿的HBV-DNA载量呈低水平持续感染状态。孕妇乳汁HBV-DNA阳性率和病毒载量均明显低于血清。婴儿接受正规乙肝基因疫苗全程免疫或主、被动联合免疫后,母乳喂养不影响母婴传播阻断效果。母乳喂养有助于提高婴儿抗-HBs的GMT水平。更多还原

【Abstract】 [Objectives] To investigate the relationship between the load of HBV-DNA in serum and breast milk of pregnant women with HBV carrier and explore the blocking effect on HBV the mother-infant transmission. [Methods] Content of HBV-DNA and HBVM in blood specimen and breast milk specimen of 167 HBV positive pregnant women and blood specimen of their 24 months old infants were delected by FQ-PCR and EIA. 167 infants of HBV positive pregnant women were received by breast feeding and artifiocial feeding. Follw-up of the two groups of infants were taken at the age of 3(T(Time)3),9(T9),12(T12), 24(T24) months old. [Results] HBV-DNA positive rate of the blood and breast milk of HBsAg, HBeAg positive pregnant women was 100% and 49.45%, (P <0.005); the average concentration of HBV-DNA was (7.43±1.81) and (4.02±1.03); but HBV-DNA positive rate of the blood and breast milk of only HBsAg positive pregnant women were 77.63% and 13.16%, (P <0.001). The average concentration of HBV-DNA was (5.76±0.82) and (3.42±0.35). The HBV-DNA of colostrum outletting rate increased with the HBV-DNA level increasing in blood of the pregnant women. The infants of HBsAg, HBeAg positive mother received breast feeding and artificial feeding. The infective rate of HBV in the two groups infants were 15.63% and 13.56%, there was no stalistical significance (χ2=0.028, P >0.05); the infants of only HBsAg positive mother receiveed breast feeding and artificial feeding. The two groups infants were not infected by HBV. The anti-HBs of 167 infants were detected, the GMT of anti-HBs for breat feeding group was higher than that of artifical feeding group. The load of HBV-DNA of 13 infants were infected by HBV were (3.24±0.23). [Conclusion] The load of HBV-BNA in blood specimen of HBV positive pregnants women is more than 109 cps/mL, and the newborns of them are high risk population to HBV vertical transmission. The concentration of HBV with the infants were infected by HBV is less than 104 cps/mL. The positive rate and the content of HBV-DNA in colostrum is less than that in serum of pregnant women obviously. The newborns of HBV positive mother received the combined immunization of HBvac and HBIG, the breast feeding does not influence the blocking effect on HBV mother-infant transmission, the breast feeding assists the GMT of anti-HBs level increasing in blood of infants.更多还原