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目的探讨新生儿外周血单个核细胞(PBMC)感染乙型肝炎病毒(HBV)的机制及意义。方法选择84例HBsAg阳性、HBeAg阴性的孕妇及其分娩的新生儿为研究组。16例HBsAg阴性孕妇及其分娩的新生儿作为对照。ELISA检测新生儿HBV血清学标志物(HBVM),巢式PCR(n-PCR)检测孕妇及新生儿血清和PBMC中HBVDNA。对血清HBsAg及HBVDNA阴性、仅PBMC中HBVDNA阳性的新生儿随访1年,观察HBsAb产生及PBMC中HBVDNA存在状况。结果(1)84例孕妇血清HBVDNA阳性45例(53.57%);PBMC中HBVDNA阳性34例(40.48%),两者相比差异无统计学意义(χ2=2.891,P>0.05)。血清及PBMC中HBVDNA均为弱阳性。(2)研究组新生儿感染24例(28.57%)。其中仅血清HBVDNA阳性7例,仅PBMC中HBVDNA阳性11例,血清和PBMC中HBVDNA同时阳性6例,血清及PBMC中HBVDNA均为弱阳性;新生儿血清HBsAg均阴性。对照组无新生儿感染。两组新生儿感染差异有统计学意义(χ2=4.55,P<0.05)。(3)研究组新生儿11例(13.10%)仅PBMC中HBVDNA阳性,均为弱阳性。其母亲仅血清HBVDNA阳性5例,仅PBMC阳性2例,血清及PBMC均阳性4例。对11例中7例仅PBMC中HBVDNA阳性的新生儿随访1年。其中4例血清HBsAb阳性,PBMC中HBVDNA阴性;3例HBsAb阴性,其中2例PBMC中HBVDNA仍为弱阳性。7例血清中HBsAg及HBVDNA均阴性。结论(1)孕妇血清或PBMC中HBVDNA阳性均可导致新生儿PBMC感染。(2)感染了HBV的PBMC可在血清HBsAg和HBVDNA阴性的新生儿体内长期存在,并影响新生儿免疫接种后HBsAb的产生。
Objective To investigate the mechanism and significance of hepatitis B virus (HBV) infection in neonates with peripheral blood mononuclear cells (PBMCs). Methods Eighty-four pregnant women with HBsAg-positive and HBeAg-negative pregnancy and their newborns were selected as the study group. Sixteen HBsAg-negative pregnant women and their newborn infants were used as controls. HBVDNA in neonates was detected by ELISA and nested PCR (n-PCR) was used to detect HBV DNA in serum and PBMC of pregnant women and neonates. Serum HBsAg and HBVDNA negative, PBMC only HBVDNA-positive newborns were followed up for 1 year to observe the HBsAb production and PBMC HBVDNA presence. Results (1) Serum HBVDNA was positive in 45 cases (53.57%) in 84 pregnant women and 34 cases (40.48%) in PBMC. There was no significant difference between the two groups (χ2 = 2.891, P> 0.05). HBVDNA in serum and PBMC are weakly positive. (2) Study group neonatal infection in 24 cases (28.57%). Among them, only serum HBVDNA was positive in 7 cases, only HBVDNA was positive in PBMC, 11 cases were HBVDNA positive in serum and PBMC, 6 cases were positive in serum and PBMC, HBVDNA in serum and PBMC were weakly positive, while HBsAg in neonates was negative. The control group had no newborn infection. There were significant differences in neonatal infection between the two groups (χ2 = 4.55, P <0.05). (3) HBVDNA was positive in PBMC only in 11 cases of study group (13.10%), both were weakly positive. His mother only seropositive HBV DNA positive in 5 cases, only PBMC positive in 2 cases, serum and PBMC were positive in 4 cases. Of the 11 cases, only HBVDNA-positive newborns in PBMC were followed up for one year. Serum HBsAb was positive in 4 cases, HBVDNA was negative in PBMC, and negative in 3 cases. HBVDNA in 2 cases was still weakly positive in 2 cases. Seven cases of serum HBsAg and HBVDNA were negative. Conclusion (1) HBVDNA positive in serum or PBMC of pregnant women can lead to neonatal PBMC infection. (2) PBMCs infected with HBV can persist in neonates with negative serum HBsAg and HBVDNA, and affect the production of HBsAb after neonatal immunization.