本文選題：乙型 + 肝炎��； 參考：《安徽醫(yī)科大學》2014年碩士論文

【摘要】：研究背景與目的 全球幾乎有近一半的人生活在HBV的高流行區(qū)，世界上有約三分之一的人口具有HBV感染的證據，25%-40%最后死于肝硬化和肝癌。我國是HBV感染的高發(fā)區(qū)，母嬰傳播是我國乙肝高發(fā)的一個重要因素,也是慢性乙型肝炎感染的主要原因,若不采取任何措施，HBV垂直傳播的危險性甚至高達90%，乙肝病毒的母嬰阻斷始終是世界各國極為重視的問題。因此，本文對部分乙肝病毒攜帶孕婦的血液、乳汁和唾液的HBV和HBV-DNA載量進行了檢測，探討母體HBV感染狀態(tài)和HBV-DNA載荷與嬰兒垂直傳播的關系。本文按照孕婦乙肝兩對半檢測結果和DNA拷貝進行分組，分別追蹤觀察其嬰兒出生時的的HBV感染情況，旨在為HBV垂直傳播阻斷和預防提供理論和實驗依據。 方法 將115例乙肝表面抗原(HBsAg)陽性的孕婦分為4組：第一組，，乙肝表面抗原（HBsAg）,乙肝e抗原（HBeAg）,乙肝核心抗體（HBcAb）陽性組；第二組，乙肝乙肝表面抗原（HBsAg）,乙肝e抗體(HBeAb）,乙肝核心抗體(HBcAb)陽性組；第三組，乙肝表面抗原（HBsAg）,乙肝核心抗體(HBcAb)陽性組；第四組，乙肝表面抗原（HBsAg）,乙肝e抗原（HBeAg）陽性組,對上述孕婦血液、乳汁和唾液進行乙肝表面抗原（HBsAg）、乙肝表面抗體（HBsAb）、乙肝e抗原（HBeAg）、乙肝e抗體（HBeAb）、乙肝核心抗體（HBcAb）及HBV病毒載量（HBV-DNA值）進行檢測,對孕婦所生的新生兒在出生后24小時內進行乙肝表面抗原（HBsAg）、乙肝表面抗體（HBsAb）、乙肝e抗原（HBeAg）、乙肝e抗體（HBeAb）、乙肝核心抗體（HBcAb）的檢測。 結果 乙肝HBsAg, HBeAg, HBcAb陽性（大三陽）和乙肝HBsAg, HBeAb, HBcAb陽性（小三陽）孕婦對新生兒垂直傳播幾率無顯著差異（P0.05）；與小三陽相比大三陽孕婦乳汁中攜帶乙肝病毒的負荷較高(P0.05)，而兩組孕婦唾液中攜帶乙肝病毒未見顯著差異(P0.05)。孕婦乙肝HBsAg, HBeAg, HBcAb陽性（大三陽）孕婦血液HBV-DNA拷貝明顯高于乙肝HBsAg, HBeAb, HBcAb陽性（小三陽）孕婦,大三陽孕婦新生兒發(fā)生宮內感染者14.3%。孕婦體內HBV-DNA值105基因拷貝/ml時發(fā)生新生兒宮內感染明顯高于體內HBV-DNA值105基因拷貝/毫升（P0.01）。 結論 孕婦攜帶乙肝大三陽和乙肝小三陽都可對新生兒產生宮內感染的威脅，但乙肝大三陽孕婦或體內HBV-DNA載量高是新生兒宮內感染的重要危險因素,在新生兒宮內感染中占比較大的比例，應及時給予阻斷,本研究結果提示，產后及時采取聯合免疫措施，減少乙肝患兒的發(fā)生。 HBsAg陽性的孕婦，其乳汁中攜帶HBsAg有顯著性差異，而唾液中攜帶HBsAg沒有區(qū)別的，大三陽孕婦同時HBV-DNA載量高時須謹慎母乳喂養(yǎng)，小三陽孕婦哺乳時要檢測HBV-DNA載量，以防止經乳汁的傳播。
[Abstract]:Research background and purpose Nearly half of the world's population lives in highly endemic areas of HBV, and about 1/3 of the world's population has evidence of HBV infection-25 to 40 percent of the world's last deaths from liver cirrhosis and liver cancer. China is a high incidence area of HBV infection. Mother-to-child transmission is an important factor in the high incidence of hepatitis B in China, and it is also the main cause of chronic hepatitis B infection. If we do not take any measures to prevent the vertical transmission of HBV, the risk of HBV vertical transmission is even as high as 90%, the blocking of mother and child of hepatitis B virus has always been a serious problem all over the world. Therefore, the HBV and HBV-DNA loads in blood, milk and saliva of some pregnant women with HBV were detected, and the relationship between maternal HBV infection status, HBV-DNA load and vertical transmission of infants was discussed. In order to provide theoretical and experimental evidences for blocking vertical transmission of HBV and preventing HBV infection in infants, this paper divided them into two groups according to the results of two pairs of semi-detection and DNA copies of hepatitis B in pregnant women, and observed the infantile HBV infection in their infants. Method 115 pregnant women with hepatitis B surface antigen (HBsAg) positive were divided into four groups: the first group was HBsAg positive group, the second group was HBcAbpositive group. Hepatitis B surface antigen (HBsAg), hepatitis B e antibody (HBeAb), hepatitis B core antibody (HBcAb) positive group; group III, hepatitis B surface antigen HBsAg (HBsAg), hepatitis B core antibody (HBcAb) positive group; group IV, hepatitis B surface antigen HBsAg (HBsAg), hepatitis E antigen (HBeAg) positive group, for the blood of the pregnant women mentioned above, Milk and saliva were tested for HBsAg, HBV-DNA, HBV-DNA, HBV-DNA, HBV-DNA, HBeAg, HBeAg, HBeAb, HBcAband HBV-DNA, HBV-DNA, HBV-DNA, HBV-DNA, HBV-DNA, HBV-DNA, HBV-DNA, HBV-DNA, HBV-DNA, HBV-DNA, HBV-DNA, HBV-DNA, HBV-DNA, HBV-DNA and HBV-DNA. Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAg), hepatitis E antigen (HBeAg), hepatitis B e antibody (HBeAb), hepatitis B core antibody (HBcAb) were detected within 24 hours after birth. Result There was no significant difference in the probability of perpendicular transmission between the pregnant women with hepatitis B HBsAg, HBeAg, HBcAb positive (Big three positive) and hepatitis B HBsAg, HBeAb, HBcAb positive (small three positive) (P 0.05), and the pregnant women with hepatitis B virus had a higher burden of carrying hepatitis B virus in milk compared with the small three positive women (P 0.05), but there was no significant difference in the rate of perpendicular transmission between the pregnant women and the small three positive pregnant women. There was no significant difference between the two groups in carrying HBV in saliva. The blood HBV-DNA copy of pregnant women with HBsAg, HBeAg, HBcAb positive hepatitis B (positive third positive group) was significantly higher than that with hepatitis B HBsAg, HBeAb, HBcAb positive (small three positive group). The incidence of intrauterine infection in neonates with HBV-DNA 105 gene copy / ml in pregnant women was significantly higher than that in pregnant women with HBV-DNA 105 gene copy / ml (P0.01). Conclusion Pregnant women with hepatitis B positive third positive and small hepatitis B three positive could threaten their newborns with intrauterine infection. However, high HBV-DNA load in pregnant women or in their bodies is an important risk factor for intrauterine infection of newborns. The results of this study suggest that the combined immunological measures should be taken promptly to reduce the incidence of hepatitis B. The pregnant women with HBsAg positive had significant difference in carrying HBsAg in milk, but there was no difference in carrying HBsAg in saliva. Pregnant women with high HBV-DNA load should be carefully breast-fed, while pregnant women with small three yang should be tested for HBV-DNA load when breast-feeding. To prevent the spread of milk.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R714.251

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