【作者】 晏路标；

【导师】 肖昕；

【作者基本信息】 暨南大学 ， 儿科学， 2006， 硕士

【摘要】 目的 分析乙型肝炎病毒(HBV)经胎盘母婴垂直传播时胎盘结构变化及HBV感染与Hofbauer细胞的关系；探讨新生儿DC-SIGN编码基因多态性与HBV垂直传播的相关性，为HBV先天性感染的有效阻断提供新思路。 方法 产检时外周血HBsAg和HBV-DNA均阳性的孕妇156例，其分娩的新生儿于生后24h内检测外周血HBsAg及HBV-DNA。21例母亲及其新生儿血清HBsAg和HBV-DNA均为阳性，归为垂直传播组；135例母亲HBsAg和HBV-DNA阳性，但其分娩的新生儿HBsAg和HBV-DNA均阴性，归为非垂直传播组。另选择30例HBsAg和HBV-DNA均阴性孕妇为正常对照组。应用光学显微镜和免疫组织化学观察三组HBV的感染后胎盘一般结构的变化及HBV感染与Hofbauer细胞的关系；应用透射电镜观察三组超微结构的改变；应用分子生物学技术分析三组新生儿DC-SIGN编码基因重复区序列多态性及其与HBV感染垂直传播的相关性。 结果 ①垂直传播组和非垂直传播组孕妇的胎盘组织存在坏死、水肿、绒毛动脉硬化、绒毛间质纤维化和纤维素样沉积、多形核白细胞、淋巴细胞、颗粒细胞浸润；正常对照组孕妇的胎盘底板极少有水肿和坏死，间质致密，结构完整，绒毛分枝细而密，少见有水肿。②垂直传播组胎盘HBsAg阳性率为100.0％，非垂直传播组为58.0％，差异具有显著性(P=0.0126)。HBsAg阳性信号主要出现在滋养细胞、Hofbauer细胞和血管内皮细胞。③垂直传播组胎盘的Hofbauer细胞数目明显增加，结合HBV的阳性Hofbauer细胞明显高于非垂直传播组和对照组(P＜0.01)。④垂直传播组的胎盘超微结构改变比非垂直传播组和正常对照组变化明显，表现为合体细胞增生、变性坏死，滋养细胞染色质边聚、细胞空化、粗面内质网肥大，线粒体肿胀、糖原颗粒聚集，可见凋亡前体和凋亡小体。⑤垂直感染组和非垂直感染组胎盘中病毒颗粒、病毒包涵体和病毒抗原颗粒单个或多个出现在合体细胞、滋养层细胞和Hofbauer细胞胞质空泡、细胞间隙内。⑥垂直感染组(21例)和正常对照组(30例)新生儿DC-SIGN编码基因重复区序列均为7／7纯合子，非垂直感染组(135例)中有1例为7／6杂合子，1例为7／8杂合子，其余为7／7纯合子。更多还原

【Abstract】 Objectives Analyzing the change in placental structure in the mother-to-neonate vertical transmission of hepatitis B virus (HBV), and the reelation of HBV transmission with placental Hofbauer cells. Investigating the relationship between mother-to-neonate vertical transmission of HBV and the neonatal DC-SIGN gene diversity, so that provid the new tips for the prevention and control of vertical transmission of HBV.Methods One hundred and fifty-six pregnant women with seropositive HBsAg and HBV-DNA were determined in prenatal care, and HBsAg and HBV-DNA from peripheral blood of their neonates were assayed 24 hours after birth. Congential infections were diagnosed if serum HBsAg and HBV-DNA positive in their neonates. So, 21 cases (seropositive HBsAg and HBV-DNA in both mothers and their neonates) were divided into Group vertical transmission (VT), 135 cases (seropositive HBsAg and HBV-DNA in mothers, but seronegative HBsAg and HBV-DNA in their neonates) were divided into Group non-vertical transmission (NVT). In addition, 30 cases (seronegative HBsAg and HBV-DNA in both mothers and their neonates) were selected into Group control. The general structure change in placentas, the correlation of HBV transmission with placental Hofbauer cells were determined by photomicroscopy and inmumohistochemical techniques; the utramicrostructure change in placentas were determined by transmission electronic microscopy. Neonatal DC-SIGN gene diversity by molarcularo- biological techniques, and the relationship between the mutation of DC-SIGN gene and HBV congential infections was analyzed.Results (1)necrosis, edema, villi capillary sclerosis, intravillifibrosis, fibrinoial sendimentation, morphokarrioleukocyet, lymphocyte and granulocyte were observed in placentas both Group VT and NVT. There were less necrosis, edema, but structure integrity, villi slenderness and pykno in the placentas of Control. (2)Placental HBsAg postive rate in Group VT was 100%, but 58% in Group NVT.更多还原