HBV感染对胎盘表型及胎盘效率影响的临床观察*

Clinical observation on the effect of HBV infection on placental phenotype and placental efficiency*

摘要:

目的 探讨乙型肝炎病毒（HBV）感染的胎盘发生胎盘表型及胎盘效率的改变，寻找其中规律，为HBV母婴传播的早期诊断提供理论依据。方法 选取2016年10月—2017年5月延安大学附属医院132例HBsAg（+）足月妊娠孕妇临产前胎盘表型及分娩后的胎盘组织作为研究对象。于孕妇临产前B超下测量胎盘长轴长度（长）、短轴长度（宽）、厚度、估算胎盘重量及胎儿重量，并计算胎盘体积及其效率；采用化学发光微粒子免疫法（CMIA）及聚合酶链反应（PCR）检测分娩后胎盘组织HBsAg定性和/或HBV DNA定性。结果 132例HBsAg（+）孕妇分娩的132例胎盘中，HBsAg（+）和/或HBV DNA（+）11例，阴性121例。阳性率为8.33%（11/132）；HBV感染阳性的胎盘长度、体积及效率与HBV感染阴性比较，差异有统计学意义（P?<0.05），前者较后者小；两者宽度比较，差异无统计学意义（P?>0.05）。结论 HBV感染可使胎盘形态发生改变，且早在胎盘时期已经表型出来。HBV感染可使胎盘长度、体积减小，效率明显降低，从而影响胎盘功能，最后导致HBV宫内感染的发生。

Abstract:

Objective To explore the changes of placental phenotype and placental efficiency in the placenta of HBV infection, and to find out the regularity of mother to child transmission. Methods Totally 132 cases of pregnant women with HBsAg (+) full term pregnancy were studied. Measurement of the length (length), length (width), thickness, estimated placental weight and fetal weight of the placenta before the B-ultrasound of the pregnant woman, and calculation of placenta volume and efficiency were performed; by chemiluminescent microparticle immunoassay (CMIA) and PCR technique, the characterization of HBsAg and HBV DNA of placental tissue after delivery was detected. Results Among 132 cases of HBsAg (+) placenta, 11 cases of HBsAg and/or HBVDNA were positive and 121 cases were negative. The positive rate is 8.33% (11/132). Compared with the negative group, the former placenta length, volume and efficiency are smaller in the positive group, and the difference is statistically significant (P??0.05). Conclusion HBV infection can change the morphology of placenta, and it has been phenotype as early as the placenta period. HBV infection can greatly reduce the length, volume and efficiency of the placenta, thus affecting the function of the placenta, and finally lead to the occurrence of HBV intrauterine infection.