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目的探讨胎盘凋亡及外周血单个核细胞(PBMC)母-胎转运与HBs Ag阳性孕妇新生儿PBMC HBs Ag的关系。方法用等位基因特异性PCR(As-PCR)筛选母儿信息病例对,用原位末端杂交法检测HBs Ag阳性孕妇足月胎盘凋亡指数,用免疫荧光双标法检测新生儿PBMC涂片上的HBs Ag和谷胱甘肽S转移酶(GST);采用SPSS 16.0软件进行分析。结果 86例新生儿PBMC中20例(23.26%)HBs Ag阳性,31例(36.05%)GST阳性,HBs Ag、GST共存者13例(15.12%);发生PBMC母-胎转运组的胎盘凋亡指数与未发生转运组的胎盘凋亡指数差异有统计学意义(t’=2.38,P=0.02),且胎盘滋养层细胞凋亡率高与PBMC转运相关(t=2.75,P=0.01);新生儿PBMC HBs Ag阳性组的胎盘细胞凋亡指数与阴性组的胎盘细胞凋亡指数差异无统计学意义(t=0.34,P=0.74);PBMC转运与新生儿PBMC HBs Ag阳性有关(χ2=9.48,P=0.00),发生PBMC转运的新生儿发生PBMC HBs Ag阳性的危险性是未发生PBMC转运新生儿的4.95倍(OR=4.95,95%CI=1.70~14.39)。结论妊晚期胎盘细胞凋亡增加有利于PBMC母-胎转运,感染HBV的PBMC可能通过胎盘进入胎儿血循环进而导致新生儿HBV感染。
Objective To investigate the relationship between placental apoptosis and peripheral blood mononuclear cells (PBMC) maternal-fetal transport and HBs Ag in neonates with HBsAg-positive pregnant women. Methods The allele-specific PCR (As-PCR) was used to screen maternal and infant information pairs. The full-term placental apoptosis index of HBsAg-positive pregnant women was detected by in situ hybridization. The neonatal PBMC smears HBs Ag and glutathione S-transferase (GST) were analyzed by SPSS 16.0 software. Results HBsAg was positive in 20 (23.26%) PBMCs of 86 neonates, 31 (36.05%) were GST positive, and 13 (15.12%) were HBsAg and GST co-existed. There was a significant difference in the index of placental apoptosis between the index group and the non - transfusion group (t ’= 2.38, P = 0.02). The high rate of apoptosis of the placental trophoblastic cells was associated with PBMC transport (t = 2.75, P = 0.01) There was no significant difference in the index of placental cell apoptosis between neonatal PBMC HBs Ag positive group and negative group (t = 0.34, P = 0.74). The PBMC transport was positively correlated with HBs Ag positive in neonates with PBMC (χ2 = 9.48, P = 0.00). The risk of PBMC HBsAg positive in PBMCs was 4.95 times of that of non-PBMCs (OR = 4.95,95% CI = 1.70-14.39). Conclusion Increased apoptosis of placental cells during the third trimester of pregnancy contributes to the maternal-fetal transport of PBMC. PBMC infected with HBV may enter the fetal blood circulation through the placenta and lead to neonatal HBV infection.