| Objective:This study was designed to analyze the serum HBV markers and HBV DNA of HBs Ag-positive mothers and their infants, help to research the influence factors of intrauterine transmission and the mechanism of HBV intrauterine infection, and to explore the different strategy for interdiction of maternal-neonatal transmission.Method: 1 We recruited 318 cases of HBs Ag-positive mothers from the Shijiazhuang maternal and child health Hospital between January 2013 and June 2013. Collect venous blood of mothers and cord blood of their infants. Record the basic information of mothers, delivery way and the basic situation of newborns.2 The infants were vaccinated with hepatitis B immune globulin(HBIG) 200 IU immediately after birth and were vaccinated with hepatitis B vaccine 20 μg at birth and at one month, six months after birth. Blood samples were collected at birth and one months and six month after birth, respectively.3 Serum HBV makers in these samples were detected by using Abbott particles chemiluminescence(Abbott i2000). Serum HBV-DNA was detected by real-time PCR Assay.Result: 1 In this study, 318 HBs Ag-positive mothers and their infants were enrolled. The age of mothers was between 19 and 42 years and mean age was 29 years.118( 37.11%) mothers were both HBs Ag-positive and HBe Ag-positive, 200(62.89%)mothers were only HBs Ag-positive. 206 cases(64.78%) were HBV-DNA positive,112 cases(35.22%) were HBV-DNA negative in their mothers. In HBe Ag-positive mothers group,the positive rate of HBs Ag in cord blood and in one month, six months and twelve months after birth of blood were 30.50%(36/118), 5.93%(7/118), 5.08%(6/118), 5.08%( 6/118) respectively. In HBe Ag-negative mothers group, the corresponding positive rate were 12.00%(24/200), 0%(0/200), 0%(0/200), 0%(0/200)respectively, with significant differences(P<0.05).2 The analysis of HBV intrauterine transmission factors showed that the rate of intrauterine transmission in maternal HBe Ag positive and negative groups were 11.02% and 1.00% respectively, and were 8.82% and 1.65% in pregnant women HBV-DNA≥106 group and HBV-DNA<106 group respectively, both with significant differences(P<0.01). HBe Ag-positive and high load HBV-DNA was the main factors of intrauterine transmission. And maternal age, liver function and mode of delivery had no significant effect on intrauterine infection.3 Serum HBs Ag, HBe Ag and anti-HBc titers in maternal blood were(> 250),(432.7 ± 821.9),(11.28 ± 1.3), and the corresponding umbilical cord blood titers were(5.36 ± 65.2),(53.8 ± 261.3),(11.02 ± 1.7) respectively. HBs Ag and HBe Ag titers in cord blood were significantly lower than the titers in maternal blood(P<0.01), while the concentration of cord blood anti-HBc was close to that of pregnant women(P>0.1).4 Follow-up cord blood HBe Ag-positive and HBe Ag-negative group, protective antibody levels in both groups showed a continuous increasing trend. Serum anti-HBs titers were(139.40 ± 121.06) and(280.68 ± 253.60) in HBe Ag-positive and negative groups at 6 months after birth respectively. There was a significant difference(P<0.05).5 At birth, the interdiction of maternal-neonatal transmission failure rates were 0%(0/82) and 16.67%(6/36) in the umbilical cord blood HBs Ag negative and positive groups respectively, and were 0%(0/28) and 75%(6/8) three days after birth. HBs Ag positive and negative groups MTCT failure rates were significantly different(P<0.01). The positive predictive value of HBs Ag-positive in cord blood was 16.67%, and was 75% three days after birth.Conclusion:1 Hepatitis B intrauterine transmission occurred in newborns whose mothers were both HBs Ag and HBe Ag positive and high load HBV-DNA. It has none relationship with maternal age, liver function and mode of delivery.2 Maternal peripheral blood HBs Ag, anti-HBs, HBe Ag, anti-HBe and anti-HBc can penetrate through the placental barrier to the fetus, and the titers of cord blood anti-HBs, anti-HBe and anti-HBc is very close to the titers in maternal blood. HBV particle size may play a key role in its ability through the placental barrier.3 The persistence of HBe Ag can affect protective antibody titers of newborns at 6 months of age. The HBs Ag positive in both cord blood and venous blood of three-day-old newborn do not represent HBV infection, but it can predict HBV interdiction of maternal-neonatal transmission failure, help to explore different measures to further reduce the rate of mother to child transmission. |
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