本文選題：慢性乙型肝炎病毒 + 宮內(nèi)感染　； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:采集新生兒的臍血進行細胞免疫學(xué)檢測,探討河北地區(qū)HBV宮內(nèi)感染新生兒臍血T淋巴細胞亞群的特點,分析T淋巴細胞亞群與新生兒免疫狀態(tài)的關(guān)系,并對新生兒宮內(nèi)感染的影響因素及其對新生兒免疫功能的影響進行進一步探索,為河北地區(qū)新生兒HBV宮內(nèi)感染的早期診斷、預(yù)防和臨床治療提供新思路,并為臨床診治新生兒罹患感染性疾病提供具有潛在意義的指標。方法:選擇河北醫(yī)科大學(xué)第一醫(yī)院及石家莊市第五醫(yī)院2016年5月至2016年12月河北地區(qū)漢族孕產(chǎn)婦分娩的新生兒45例。研究對象分為病例組[HBV表面抗原陽性(HBsAg)孕婦分娩新生兒]36例,其中包括宮內(nèi)感染組7例和宮內(nèi)未感染組29例,并選擇同期正常孕婦分娩新生兒9例為對照組。所有孕婦均采集外周血并采用酶聯(lián)免疫吸附法(ELISA)測定乙型肝炎病毒標志物(乙肝五項)指標,新生兒臍血送合作單位河北醫(yī)科大學(xué)動物實驗中心均測乙肝五項和HBV-DNA,并采用流式細胞術(shù)檢測T細胞亞群。分析三組臍血T淋巴細胞亞群的百分比。結(jié)果:1本次分析的45例新生兒中,感染組、未感染組、對照組分別為7例、29例、9例。其宮內(nèi)感染組(共7例)中1例HBV-DNA為陽性,5例HBsAg均為陽性,1例HBsAg和HBV-DNA均為陽性,孕產(chǎn)婦HBV宮內(nèi)感染率為15.56%(7/45)。2在感染組、未感染組、對照組三組中,CD19+、NK細胞陽性率在三組間的差異均無統(tǒng)計學(xué)意義(H=3.59、0.80,P均0.05);CD3、CD4、CD8以及CD4/CD8,感染組與未感染組,感染組與對照組三組間差異均有統(tǒng)計學(xué)意義,而未感染組與對照組間差異無統(tǒng)計學(xué)意義。其中CD3+表達(%)分別為(59.71±7.18)、(70.83±11.40)、(77.87±9.50),三組間差異均有統(tǒng)計學(xué)意義(F=5.83,P=0.006),兩兩比較后,CD3+陽性率,感染組明顯低于未感染組及對照組,差異均有統(tǒng)計學(xué)意義(P0.05);3組CD4+表達(%)分別為40.90(36.20,42.10)、53.30(44.45,58.25)、50.50(45.20,56.95),感染組明顯低于未感染組及對照組,三組間差異均有統(tǒng)計學(xué)意義(F=9.14,P=0.01),兩兩比較后,CD4+陽性率,感染組明顯低于未感染組及對照組,差異均有統(tǒng)計學(xué)意義(P0.05);3組CD8+表達(%)分別為29.50(26.00,33.10)、18.40(14.20,24.35)、24.80(18.20,27.30),感染組明顯高于未感染組及對照組,組間差異比較均存在顯著性(F=9.25,P0.05);3組CD4+/CD8+比值分別為1.38(1.23,1.61)、2.75(2.07,3.47)、2.22(1.85,2.82),感染組明顯低于未感染組及對照組,三組間差異均有統(tǒng)計學(xué)意義(F=11.32,P=0.003),兩兩比較后,CD4+/CD8+比值,感染組明顯低于未感染組及對照組,差異均有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:宮內(nèi)感染HBV新生兒可能存在T淋巴細胞亞群比例失調(diào),T淋巴細胞亞群水平較低,提示機體感染后細胞免疫功能減低。
[Abstract]:Objective: to investigate the characteristics of T lymphocyte subsets in umbilical cord blood of newborns with HBV intrauterine infection in Hebei, and to analyze the relationship between T lymphocyte subsets and the immune status of newborns. The influencing factors of intrauterine infection of newborn and its influence on neonatal immune function were further explored in order to provide new ideas for early diagnosis, prevention and clinical treatment of HBV intrauterine infection in newborns in Hebei province. It also provides a potential index for clinical diagnosis and treatment of neonatal infectious diseases. Methods: 45 newborns were selected from the first Hospital of Hebei Medical University and the Fifth Hospital of Shijiazhuang City from May 2016 to December 2016. The subjects were divided into three groups: 36 cases of newborns delivered by HBsAg positive pregnant women, including 7 cases of intrauterine infection group and 29 cases of intrauterine uninfected group, and 9 cases of normal pregnant women giving birth as control group. Peripheral blood samples were collected from all pregnant women and the markers of hepatitis B virus (HBV) were determined by enzyme linked immunosorbent assay (Elisa). Five items of hepatitis B and HBV-DNA were measured in the animal experimental center of Hebei Medical University, and T cell subsets were detected by flow cytometry. The percentage of T lymphocyte subsets in umbilical cord blood was analyzed. Results among 45 newborns in this analysis, 7 cases were infected, 9 cases were uninfected, and 9 cases were control group. In the intrauterine infection group (7 cases), 1 case was positive for HBV-DNA, 5 cases were positive for HBsAg and 1 case was positive for HBsAg and HBV-DNA. The intrauterine infection rate of HBV in pregnant women was 15.56% (7 / 45) in infected group and non-infected group. There was no significant difference in the positive rate of CD19 + NK cells between the three control groups (P 0.05). The positive rates of CD3 + CD4 / CD8 and CD4 / CD8 were significantly different between the infected group and the uninfected group, and between the infected group and the control group. There was no significant difference between the uninfected group and the control group. The expression of CD3 was (59.71 鹵7.18), (, 70.83 鹵11.40), (, 77.87 鹵9.50), and the difference among the three groups was statistically significant (F5. 83, P0. 006). The positive rate of CD3 in the infected group was significantly lower than that in the uninfected group and the control group. The expression of CD4 in the three groups was 40.90 (36.2042.10), 53.30 (44.45.58.25) and 50.50 (45.2056.95) respectively. The positive rate of CD4 was significantly lower in the infected group than in the uninfected group and the control group (F9.14Pn0.01). The positive rate of CD4 in the infected group was significantly lower than that in the uninfected group and the control group. There were significant differences in CD8 expression (P 0.05) between the three groups (P 0.05). The expression of CD8 in the three groups were 29.50 (26.003.10) and 18.40 (14.204.35), 24.80 (18.200.27.30), respectively. The difference between the infected group and the non-infected group and the control group was significant (FF9.25P0.05). The CD4 / CD8 ratio of the 3 groups was 1.38 (1.231.61) / 2.75 (2.073.47) 2.22 (1.852.82), respectively, which was significantly lower than that of the uninfected group and the control group. There were significant differences among the three groups (F _ (11.32) P _ (0. 003). The ratio of CD _ 4 / CD _ 8 in the infection group was significantly lower than that in the non-infection group and the control group (P0.05). Conclusion: the level of T lymphocyte subsets may be low in intrauterine HBV neonates, suggesting that the cellular immune function is decreased after infection.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R722.1

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