本文選題：大理白族　切入點(diǎn)：HBV　出處：《大理學(xué)院》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景：慢性乙型肝炎是一種病毒性感染，是目前世界范圍內(nèi)嚴(yán)重的公共衛(wèi)生問題之一，給社會(huì)及家庭的健康帶來了嚴(yán)重的影響。目前全球范圍內(nèi)乙型肝炎病毒（HBV）慢性感染者已經(jīng)達(dá)到甚至超過了3.5億【1,2】，而1/3以上已經(jīng)出現(xiàn)嚴(yán)重的肝臟疾病，每年約100萬人【3】死于乙型肝炎病毒感染相關(guān)的疾病，包括【4】慢性肝炎、肝纖維化、肝硬化和肝細(xì)胞癌。我國是HBV的高分布區(qū)，人群攜帶病毒率呈逐漸增加的趨勢，與乙型肝炎病毒感染相關(guān)的疾病也逐漸增多且病情復(fù)雜化。但總的來說，這些疾病的發(fā)展與演變均與乙型肝炎表面抗原（HBsAg）持續(xù)存在密不可分。故研究清除HBsAg的途徑尤為重要。研究發(fā)現(xiàn)，乙肝的發(fā)病率在全球不同的地方差異較大。這些差異主要與疾病的感染途徑及病毒的相關(guān)性狀有一定的關(guān)系。在乙肝的傳播途徑中，母嬰傳播被認(rèn)為是最主要的傳播途徑，且胎兒及新生兒時(shí)期感染乙肝病毒后，大約90%【5】以上會(huì)轉(zhuǎn)為慢性乙肝病毒攜帶者，病毒難以清除，成年后發(fā)展為肝硬化及肝癌的概率也將明顯增多。故控制乙肝病毒的發(fā)展，降低人群中與乙肝病毒感染相關(guān)的疾病的發(fā)病率，主要在于探討母嬰間的傳播。母嬰間的傳播主要是宮內(nèi)傳播，宮內(nèi)傳播與孕婦的感染狀況及不同型別的病毒基因有關(guān)，同時(shí)孕婦孕期免疫狀態(tài)、感染病毒模式、分娩方式等都將影響母嬰傳播。 目的：探討大理州白族孕婦及新生兒感染的HBV基因分布、病毒攜帶狀態(tài)與母嬰傳播的相關(guān)問題。 方法：本實(shí)驗(yàn)采集云南省大理白族自治州大理學(xué)院附屬醫(yī)院、大理市第一人民醫(yī)院、大理市婦幼保健院2011年12月至2013年09月住院分娩HBV陽性白族孕婦血清及分娩的新生兒臍血，分別采集孕婦血清及新生兒臍血87例。首先采用ELISA檢測標(biāo)本乙肝兩對半模式，再應(yīng)用熒光PCR對符合標(biāo)本進(jìn)行基因型檢測；對乙肝標(biāo)志物陽性者行定量PCR檢測HBV DNA含量。進(jìn)行重復(fù)試驗(yàn)，實(shí)驗(yàn)數(shù)據(jù)用SPSS16.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析和處理，兩組間率的比較采用卡方檢驗(yàn)，均以α=0.05為檢驗(yàn)水準(zhǔn)，P 0.05有統(tǒng)計(jì)學(xué)意義。 結(jié)果：87份孕婦血清中，B基因型40例（45.98%），C基因型19例（21.84%），B+C基因型18例（20.69%），B+E基因型2例（2.30%），，未分型8例（9.20%）；41例HBeAg陽性者血清中HBV-DNA陽性為35例（85.37%），46例HBeAg陰性者血清中HBV-DNA陽性為12例（26.09%）；87例孕婦足月分娩87例新生兒中，乙肝表面標(biāo)志物陽性者有48例；48例乙肝標(biāo)志物陽性新生兒中，來自母HBeAg陽性者為35例，來自母HBeAg陰性者為13例；48例新生兒檢測HBV DNA，其中陽性27例；48例新生兒行HBV基因分型，結(jié)果B基因型18例（37.50%），C基因型8例（16.67%），B+C基因型12例（25.00%），其余未分型10例（20.83%）；50例足月剖宮產(chǎn)兒中HBV-DNA陽性者18例（36%），37例足月順產(chǎn)兒中HBV DNA陽性者9例（24%）。 結(jié)論：1大理白族孕婦感染HBV基因型主要是B型，其次是C型，存在少量的混合型基因型； 2HBV存在母嬰間的傳播，新生兒感染HBV后的基因型與孕婦一致，主要基因型是B型； 3大理白族孕婦感染HBV后，B基因型的孕婦發(fā)生HBV母嬰傳播的可能性較大； 4大理白族孕婦中，HBeAg陽性者更易檢測出HBV DNA； 5大理白族孕婦HBeAg陽性者，更易發(fā)生母嬰間的傳播； 6分娩方式的選擇并不改變大理白族孕婦及新生兒HBV母嬰間的傳播； 7研究孕婦的乙型肝炎病毒基因型為減少新生兒感染及預(yù)防嚴(yán)重肝臟疾病提供依據(jù)。
[Abstract]:Background: chronic hepatitis B is a viral infection, is one of the public health problems worldwide serious, has brought the serious influence to the society and family health. The scope of the current global chronic hepatitis B virus (HBV) infection has reached or even exceeded 350 million [1,2], which has been over 1/3 severe liver disease, about 1 million people per year [3] died of diseases related to hepatitis B virus infection [4], including liver fibrosis, chronic hepatitis, cirrhosis and hepatocellular carcinoma. China is the high distribution area of HBV, the crowd carry virus rate increased, associated with hepatitis B virus infection the disease has gradually increased and the condition is complicated. But in general, the development and evolution of these diseases are related to hepatitis B surface antigen (HBsAg) continue to exist are inseparable. So the study of the path is clear HBsAg To. The study found that the incidence of hepatitis B large local differences in the global different. There is a certain relationship between these differences and the main route of infection and virus disease. The route of hepatitis B transmission, mother to child transmission is considered the main route of transmission, and the fetal and neonatal period after infection of hepatitis B virus about 90%, [5] above will become chronic carriers of hepatitis B virus, the virus is difficult to remove, for adult probability of liver cirrhosis and hepatocellular carcinoma will be increased significantly. Therefore, the development of hepatitis B virus, reducing the population in hepatitis B virus infection and related disease incidence, investigates the mother to child transmission of the communication. Between mother and child is mainly intrauterine transmission, infection and intrauterine infection of pregnant women and different types of viral genes, and maternal immune status, infection mode, the mode of delivery will be affected Mother to child transmission.
Objective: To investigate the distribution of HBV gene in the infection of pregnant and newborn babies of Bai nationality in Dali, and the related problems of the virus carrying status and mother to child transmission.
Methods: This study collected in Yunnan Bai Autonomous Prefecture of Dali province Dali University Affiliated Hospital, Dali First People's Hospital, Dali maternal and child health hospital from December 2011 to 2013 09 months of hospital delivery and delivery serum HBV positive pregnant women Bai in umbilical cord blood, serum and umbilical cord blood of pregnant women were collected. 87 cases were first detected by ELISA were two semi hepatitis B model, then the application of fluorescence PCR according to the samples for genotyping; on HBV markers positive for quantitative detection of PCR HBV DNA. The content of repeated experiments, experimental data processing and statistical analysis was performed with the SPSS16.0 software, between the two groups was compared using the chi square test is to test the level of a =0.05, P 0.05 was statistically significant.
緇撴灉錛

本文編號(hào)：1560873