Relationship Between Intrauterine HBV Infection And Maternal HBV-DNA And Placental Toll Like Receptor 3

Objective:1.To investigate the relationship between maternal blood HBV-DNA content and fetal intrauterine infection.The serum HBV-DNA concentration in pregnant women may have a load interface that affects the rate of HBV intrauterine infection.If the maternal HBV-DNA load is controlled below this level,the incidence of intrauterine infection may be reduced.In order to prevent and block the intrauterine infection of HBV,it provides a clinical basis for the promotion of better and more standardized promotion of the use of blocking methods,and effectively reduces the vertical transmission of hepatitis B from mother to child.2.Despite the immunization prevention,10-15%of infants still develop chronic hepatitis B virus(HBV)infection through mother-to-infant transmission.By analyzing the relationship between placental tissue TLR3 and HBV infection,the reasons for the failure of intrauterine infection are discussed,indicating that persistent HBV infection is associated with down-regulation of TLR3 expression in the placental tissue,which is one of the risk factors for intrauterine infection.Methods:Selected from January 2016 to December 2016 to seek treatment for hepatitis B virus(HBV-M)in maternal hospitals in the Department of Obstetrics and Gynecology at the Lianyungang Oriental Hospital and the First People’s Hospital.Among them,104cases were HBsAg positive.According to Hepatitis B serum markers were divided into HBsAg,HBeAg,and HBcAb positive groups in 38 cases(group A),HBsAg,HBeAb,HBcAb positive group in 55 cases(group B),and HBsAg,HBcAb positive group in 9cases(group C).Positive HBsAg in 2 cases(group D).In the control group,40 normal pregnant women with negative HBsAg were selected as the control group.HBV-DNA was collected from venous blood before natural delivery or before cesarean section,serum HBV-DNA was detected from umbilical cord blood of newborns and serum markers of HBV were detected by umbilical cord blood samples from newborns.HBsAg positive pregnant women and normal pregnant women collected placental tissue quickly and aseptically during natural delivery or cesarean section.The expression of TLR3 in placenta was detected by immunohistochemical method.(1)Define HBV-DNA≥10~3 IU/ml as HBV-DNA positive,and further divide HBsAg positive maternal serum HBV-DNA into 6 levels:Level 1<10~4,Level 2<10~5,Level3<10~6,Level 4<10~7,Level5<10~8,Level 6<10~9(copy/ml),then compare the rate of intrauterine infection at each level.(2)Compare serum HBV-DNA and placental TLR3 in HBsAg-positive pregnant women.(3)To compare the expression of TLR3 in the placenta of placenta of pregnant women with HBsAg positive and normal pregnant women.Results:104 cases of HBsAg-positive pregnant women,10 cases of neonatal intrauterine infection,accounting for 9.62%;of which 3 cases of neonatal HBsAg positive,HBV-DNA positive in 7 cases,HBsAg and HBV-DNA were positive in 1 case.The intrauterine infection rates in the A,B,C,and D groups were 18.4%(7/38),5.45%(3/55),0(0/9),and 0(0/2),respectively.There was a significant difference in the rate of intrauterine infection among pregnant women in the AB group(x~2=3.937,P<0.05).Among the 104 cases of HBsAg-positive women with intrauterine infection,60 were positive for HBV-DNA and 8 were intrauterine infections.The infection rate was 13.3%(8/60).The HBV-DNA load in maternal serum was ranked separately,and the relationship between maternal different grades of HBV-DNA and HBV intrauterine infection was analyzed.The results showed that when HBV-DNA≥10~6 copies/ml,the intrauterine infection rate was significantly increased,so HBV-DNA≥10~6 copies/ml may be the load interface of intrauterine infection(x~2=5.194,P<0.05);when HBV-DNA At the 1-3 level,there was no significant difference in intrauterine infection rate(x~2=2.511,P>0.05),and there was no significant difference in intrauterine infection rate between grades 5-6(x~2=3.604,P>0.05).The positive rate of TLR3 receptor in the control group was 100%(40/40).TLR3 had strong immunoblot in all layers of placenta in 40 normal pregnant women,mainly distributed in cytoplasm and distributed in nucleus.The distribution was patchy,the positive rate in the case group was 71.2%(74/104),of which 30 cases showed no positive signal,74 cases had positive signals,46cases had positive trophoblast cells,and 30 placental decidual cells were positive.Cases of villous capillary endothelial cells were positive,72 cases of villous stromal cells were positive,showing a focal distribution(Figure 1,2).The placental distribution of TLR3in normal pregnant women placenta and HBsAg positive pregnant women was statistically significant(x~2=14.575,P<0.001).Among them,the higher the HBV-DNA load,the weaker the expression of TLR3,suggesting that TLR3 receptor may be a protective factor for HBV infection.Conclusion:Intrauterine infection of HBV can occur in HBsAg-positive pregnant women.With the increase of serum HBV-DNA levels in pregnant women,the intrauterine infection rate increases gradually,HBV-DNA≥10~6copy/ml,and the intrauterine infection rate increases significantly.Therefore,HBV-DNA≥10~6copy/ml may be the load interface for intrauterine infection.If HBV-DNA is lower than this level during pregnancy,it can effectively reduce the rate of intrauterine infection in HBV.The expression of TLR3 in placenta tissue is related to HBV infection in pregnant women.The relationship between decreased expression of TLR3 in placenta and HBV infection indicates that the failure of placental barrier may be one of the causes of vertical transmission.The higher the load of HBV-DNA,TLR3 The weaker the expression suggests that the TLR3receptor may be involved in the process of viral infection.