丙型肝炎病毒母婴感染研究及其预防现状
聂青和, 中国人民解放军第四军医大学唐都医院传染病科、全军感染病诊疗中心 陕西省西安市 710038
国家自然科学基金资助课题, No. 39970767
通讯作者: 聂青和,710038, 陕西省西安市新寺路1号, 中国人民解放军第四军医大学唐都医院传染病科、全军感染病诊疗中心. nieqinghe@hotmail.com
电话:029-83377752 传真:029-83537377
收稿日期: 2005-03-31 接受日期: 2005-04-12
摘要丙型肝炎病毒(HCV)感染在全世界估计约1亿7千万人，多数感染者呈慢性携带状态，且常进展为肝硬化和肝细胞癌.在我国一般人群感染率约3.2%.HCV经典的传播途径为经血液或血液制品传播.但1991年后，献血员HCV的筛检已使输血后丙型肝炎大为减少，HCV传播途径正在发生改变，儿童非输血、血液制品的丙型肝炎日渐增多.母婴间宫内、分娩时及产后感染已成为当前及今后研究的重要问题.现研究证实HCV可经胎盘引起胎儿感染，宫内感染是HCV传播的一条重要途径.而当前的研究多数为流行病学调查及分子生物学研究，关于HCV如何在母婴间进行传播的具体机制研究甚少.丙型肝炎在我国较常见，加之又无特效药物治疗，给国民健康带来了很大危害.目前，丙型肝炎疫苗研制受阻，难以用于人体预防，因此阻断HCV母婴传播的研究工作就显得十分重要.由此可见，研究并阐明HCV宫内传播的分子机制，针对性提出阻断方案是一项对国计民生均十分迫切而重要的课题.可以说，研究HCV的母婴感染以及如何防治HCV的母婴传播将是今后研究的重点.
, 百拇医药
关键词: 丙型肝炎病毒; 母婴感染; 传播; 预防
聂青和. 丙型肝炎病毒母婴感染研究及其预防现状. 世界华人消化杂志 2005;13(11):1257-1262
王平忠, 聂青和, 张中伟, 白宪光. 丙型肝炎病毒感染的不同人群HCV RNA定量研究. 世界华人消化杂志 2000;8:1247-1250
4 程勇前, 聂青和, 周永兴. 丙型肝炎病毒母婴传播机制研究. 世界华人消化杂志 2002;10:445-447
5 Ferrero S, Lungaro P, Bruzzone BM, Gotta C, Bentivoglio G, Ragni N. Prospective study of mother-to-infant transmission
, 百拇医药
of hepatitis C virus: a 10-year survey (1990-2000). Acta Obstet Gynecol Scand 2003;82:229-234
6 Bianca S. Hepatitis C and pregnancy. Aust N Z J Obstet Gynaecol 2004;44:375
7 Tajiri H, Miyoshi Y, Funada S, Etani Y, Abe J, Onodera T, Goto M, Funato M, Ida S, Noda C, Nakayama M, Okada
S. Prospective study of mother-to-infant transmission of hepatitis C virus. Pediatr Infect Dis J 2001;20:10-14
, http://www.100md.com
8 Murakami J, Okamoto M, Miyata H, Nagata I, Shiraki K, Hino S. Evolution in the hypervariable region of hepatitis C virus
in infants after vertical transmission. Pediatr Res 2000;48:450-456
9 Thaler MM, Park CK, Landers DV, Wara DW, Houghton M, Veereman-Wauters G, Sweet RL, Han JH. Vertical
transmission of hepatitis C virus. Lancet 1991;338:17-18
10 Kassem AS, el-Nawawy AA, Massoud MN, el-Nazar SY, Sobhi EM. Prevalence of hepatitis C virus(HCV)infection and
, http://www.100md.com
its vertical transmission in Egyptian pregnant women and their newborns. J Trop Pediatr 2000;46:231-233
11 Bonacini M, Puoti M. Hepatitis C in patients with human immunodeficiency virus infection: diagnosis, natural
history, meta-analysis of sexual and vertical transmission, and therapeutic issues. Arch Intern Med 2000;160:3365-3373
12 Thomas DL, Villano SA, Riester KA, Hershow R, Mofenson LM, Landesman SH, Hollinger FB, Davenny K, Riley L, Diaz
, http://www.100md.com
C, Tang HB, Quinn TC. Perinatal transmission of hepatitis C virus from human immunodeficiency virus type
1-infected mothers. Women and Infants Transmission Study. J Infect Dis 1998;177:1480-1488
13 Steininger C, Kundi M, Jatzko G, Kiss H, Lischka A, Holzmann H. Increased risk of mother-to-infant transmission
of hepatitis C virus by intrapartum infantile exposure to maternal blood. J Infect Dis 2003;187:345-351
, 百拇医药
14 Sitia G, Cella D, De Mitri MS, Novati R, Foppa CU, Perackis K, Bianchi C, Lazzarin A, Morsica G. Evolution of the
E2 region of hepatitis C virus in an infant infected by mother-to-infant transmission. J Med Virol 2001;64:476-481
15 Rapicetta M, Argentini C, Spada E, Dettori S, Riccardi MP, Toti M. Molecular evolution of HCV genotype 2c
persistent infection following mother-to-infant transmission. Arch Virol 2000;145:965-977
, 百拇医药
16 Kudo T, Yanase Y, Ohshiro M, Yamamoto M, Morita M, Shibata M, Morishima T. Analysis of mother-to-infant
transmission of hepatitis C virus: quasispecies nature and buoyant densities of maternal virus populations. J Med
Virol 1997;51:225-230
17 程勇前, 聂青和, 周永兴, 杜德伟, 杨华光. 人胎盘滋养层细胞的分离培养及IgGFcgRⅢ在人胎盘组织中的表达. 医学研究
生学报 2002;15:105-107
, http://www.100md.com
18 程勇前, 聂青和, 周永兴, 杨华光, 李谨革. 人滋养层细胞分离培养及HCV体外感染试验. 第四军医大学学报 2002;23:
1544-1547
19 程勇前, 聂青和, 周永兴, 黄晓峰, 杨华光. 体外感染丙型肝炎病毒的滋养层细胞超微结构变化. 中华妇产科杂志 2003;
38:28-29
20 程勇前, 聂青和, 周永兴, 黄晓峰, 罗红, 杨华光. 透射电镜及激光共聚焦技术观察体外丙型肝炎病毒感染的人胎盘
滋养层细胞. 世界华人消化杂志 2003;11:151-156
21 聂青和, 王平忠, 周永兴. 丙型肝炎病毒感染孕妇羊水中丙型肝炎病毒RNA检测的临床意义. 中华妇产科杂志 2002;
, 百拇医药
37:19-21
22 Conte D, Fraquelli M, Prati D, Colucci A, Minola E. Prevalence and clinical course of chronic hepatitis C virus
(HCV) infection and rate of HCV vertical transmission in a cohort of 15, 250 pregnant women. Hepatology 2000;
31:751-755
23 Goncales FL Jr, Stucchi RS, Pavan MH, Angerami RN, Goncales NS. Hepatitis C virus in monozygotic twins. Rev Inst
, 百拇医药
Med Trop Sao Paulo 2000;42:163-165
24 Ruiz-Extremera A, Salmeron J, Torres C, De Rueda PM, Gimenez F, Robles C, Miranda MT. Follow-up of transmission
of hepatitis C to babies of human immunodeficiency virus-negative women: the role of breast-feeding in
transmission. Pediatr Infect Dis J 2000;19:511-516
25 Polywka S, Schroter M, Feucht HH, Zollner B, Laufs R. Low risk of vertical transmission of hepatitis C virus by breast
, 百拇医药
milk. Clin Infect Dis 1999;29:1327-1329
26 Mast EE. Mother-to-infant hepatitis C virus transmission and breastfeeding. Adv Exp Med Biol 2004;554:211-216
27 Conte D, Colucci A, Minola E, Fraquelli M, Prati D. Clinical course of pregnant women with chronic hepatitis C
virus infection and risk of mother-to-child hepatitis C virus transmission. Dig Liver Dis 2001;33:366-371
, http://www.100md.com
28 Okamoto M, Nagata I, Murakami J, Kaji S, Iitsuka T, Hoshika T, Matsuda R, Tazawa Y, Shiraki K, Hino S.
Prospective reevaluation of risk factors in mother-to-child transmission of hepatitis C virus: high virus load,vaginal delivery, and negative anti-NS4 antibody. J Infect Dis 2000;182:1511-1514
29 Kowala-Piaskowska A, Figlerowicz M, Mozer-Lisewska I, Mazur-Melewska K, Pawelek T, Sluzewski W.
, http://www.100md.com
Vertical transmission of hepatitis C virus infection. Hepatol Res 2004;30:137-140
30 Kumar RM, Frossad PM, Hughes PF. Seroprevalence and mother-to-infant transmission of hepatitis C in
asymptomatic Egyptian women. Eur J Obstet Gynecol Reprod Biol 1997;75:177-182
31 Azzari C, Resti M, Moriondo M, Ferrari R, Lionetti P, Vierucci A. Vertical transmission of HCV is related to
, 百拇医药
maternal peripheral blood mononuclear cell infection. Blood 2000;96:2045-2048
32 Spencer JD, Latt N, Beeby PJ, Collins E, Saunders JB, McCaughan GW, Cossart YE. Transmission of hepatitis C virus
to infants of human immunodeficiency virus-negative intravenous drug-using mothers: rate of infection and assessment
of risk factors for transmission. J Viral Hepat 1997;4:395-409
, 百拇医药
33 Healy CM, Cafferkey MT, Conroy A, Dooley S, Hall WW, Beckett M, Clarke TA, White MJ, Gorman WA, Butler KM.
Outcome of infants born to hepatitis C infected women. Ir J Med Sci 2001;170:103-106
34 聂青和, 李梦东. 丙型肝炎疫苗研究现状及策略. 中华流行病学杂志 1998;19:47-49
35 聂青和. 基因疫苗的基础研究及应用现状. 世界华人消化杂志 2003;11:125-129
36 Cheng PN, Chang TT, Jen CM, Ko AW, Young KC, Wu HL. Molecular evidence for transmission of GB virus-C/Hepatitis
, 百拇医药
G virus infection within family: close relationship between mother and child. Hepatogastroenterology 2003;50:151-156
37 程勇前, 聂青和. HBV、HCV垂直传播机制及预防研究近况. 实用肝脏病杂志 2003;6:182-185
38 Lima MP, Pedro RJ, Rocha MD. Mother-to-infant transmission of hepatitis C virus(HCV)in Brazil. J Trop
Pediatr 2004;50:236-238
39 罗新栋, 聂青和. 特殊人群的丙型肝炎特点及处理. 世界华人消化杂志 2004;12:2390-2395
, 百拇医药
40 李梦东, 聂青和. 进一步加强慢性丙型肝炎的临床实用性研究. 世界华人消化杂志 2004;12:2365-2368
41 Simpore J, Ilboudo D, Samandoulougou A, Guardo P, Castronovo P, Musumeci S. HCV and HIV co-infection in
pregnant women attending St. Camille Medical Centre in Ouagadougou (Burkina Faso). J Med Virol 2005;75:209-212
42 聂青和. 慢性丙型病毒性肝炎的诊断与治疗. 世界华人消化杂志 2004;12:2364-2409
编辑 张海宁, 百拇医药
国家自然科学基金资助课题, No. 39970767
通讯作者: 聂青和,710038, 陕西省西安市新寺路1号, 中国人民解放军第四军医大学唐都医院传染病科、全军感染病诊疗中心. nieqinghe@hotmail.com
电话:029-83377752 传真:029-83537377
收稿日期: 2005-03-31 接受日期: 2005-04-12
摘要丙型肝炎病毒(HCV)感染在全世界估计约1亿7千万人，多数感染者呈慢性携带状态，且常进展为肝硬化和肝细胞癌.在我国一般人群感染率约3.2%.HCV经典的传播途径为经血液或血液制品传播.但1991年后，献血员HCV的筛检已使输血后丙型肝炎大为减少，HCV传播途径正在发生改变，儿童非输血、血液制品的丙型肝炎日渐增多.母婴间宫内、分娩时及产后感染已成为当前及今后研究的重要问题.现研究证实HCV可经胎盘引起胎儿感染，宫内感染是HCV传播的一条重要途径.而当前的研究多数为流行病学调查及分子生物学研究，关于HCV如何在母婴间进行传播的具体机制研究甚少.丙型肝炎在我国较常见，加之又无特效药物治疗，给国民健康带来了很大危害.目前，丙型肝炎疫苗研制受阻，难以用于人体预防，因此阻断HCV母婴传播的研究工作就显得十分重要.由此可见，研究并阐明HCV宫内传播的分子机制，针对性提出阻断方案是一项对国计民生均十分迫切而重要的课题.可以说，研究HCV的母婴感染以及如何防治HCV的母婴传播将是今后研究的重点.
, 百拇医药
关键词: 丙型肝炎病毒; 母婴感染; 传播; 预防
聂青和. 丙型肝炎病毒母婴感染研究及其预防现状. 世界华人消化杂志 2005;13(11):1257-1262
王平忠, 聂青和, 张中伟, 白宪光. 丙型肝炎病毒感染的不同人群HCV RNA定量研究. 世界华人消化杂志 2000;8:1247-1250
4 程勇前, 聂青和, 周永兴. 丙型肝炎病毒母婴传播机制研究. 世界华人消化杂志 2002;10:445-447
5 Ferrero S, Lungaro P, Bruzzone BM, Gotta C, Bentivoglio G, Ragni N. Prospective study of mother-to-infant transmission
, 百拇医药
of hepatitis C virus: a 10-year survey (1990-2000). Acta Obstet Gynecol Scand 2003;82:229-234
6 Bianca S. Hepatitis C and pregnancy. Aust N Z J Obstet Gynaecol 2004;44:375
7 Tajiri H, Miyoshi Y, Funada S, Etani Y, Abe J, Onodera T, Goto M, Funato M, Ida S, Noda C, Nakayama M, Okada
S. Prospective study of mother-to-infant transmission of hepatitis C virus. Pediatr Infect Dis J 2001;20:10-14
, http://www.100md.com
8 Murakami J, Okamoto M, Miyata H, Nagata I, Shiraki K, Hino S. Evolution in the hypervariable region of hepatitis C virus
in infants after vertical transmission. Pediatr Res 2000;48:450-456
9 Thaler MM, Park CK, Landers DV, Wara DW, Houghton M, Veereman-Wauters G, Sweet RL, Han JH. Vertical
transmission of hepatitis C virus. Lancet 1991;338:17-18
10 Kassem AS, el-Nawawy AA, Massoud MN, el-Nazar SY, Sobhi EM. Prevalence of hepatitis C virus(HCV)infection and
, http://www.100md.com
its vertical transmission in Egyptian pregnant women and their newborns. J Trop Pediatr 2000;46:231-233
11 Bonacini M, Puoti M. Hepatitis C in patients with human immunodeficiency virus infection: diagnosis, natural
history, meta-analysis of sexual and vertical transmission, and therapeutic issues. Arch Intern Med 2000;160:3365-3373
12 Thomas DL, Villano SA, Riester KA, Hershow R, Mofenson LM, Landesman SH, Hollinger FB, Davenny K, Riley L, Diaz
, http://www.100md.com
C, Tang HB, Quinn TC. Perinatal transmission of hepatitis C virus from human immunodeficiency virus type
1-infected mothers. Women and Infants Transmission Study. J Infect Dis 1998;177:1480-1488
13 Steininger C, Kundi M, Jatzko G, Kiss H, Lischka A, Holzmann H. Increased risk of mother-to-infant transmission
of hepatitis C virus by intrapartum infantile exposure to maternal blood. J Infect Dis 2003;187:345-351
, 百拇医药
14 Sitia G, Cella D, De Mitri MS, Novati R, Foppa CU, Perackis K, Bianchi C, Lazzarin A, Morsica G. Evolution of the
E2 region of hepatitis C virus in an infant infected by mother-to-infant transmission. J Med Virol 2001;64:476-481
15 Rapicetta M, Argentini C, Spada E, Dettori S, Riccardi MP, Toti M. Molecular evolution of HCV genotype 2c
persistent infection following mother-to-infant transmission. Arch Virol 2000;145:965-977
, 百拇医药
16 Kudo T, Yanase Y, Ohshiro M, Yamamoto M, Morita M, Shibata M, Morishima T. Analysis of mother-to-infant
transmission of hepatitis C virus: quasispecies nature and buoyant densities of maternal virus populations. J Med
Virol 1997;51:225-230
17 程勇前, 聂青和, 周永兴, 杜德伟, 杨华光. 人胎盘滋养层细胞的分离培养及IgGFcgRⅢ在人胎盘组织中的表达. 医学研究
生学报 2002;15:105-107
, http://www.100md.com
18 程勇前, 聂青和, 周永兴, 杨华光, 李谨革. 人滋养层细胞分离培养及HCV体外感染试验. 第四军医大学学报 2002;23:
1544-1547
19 程勇前, 聂青和, 周永兴, 黄晓峰, 杨华光. 体外感染丙型肝炎病毒的滋养层细胞超微结构变化. 中华妇产科杂志 2003;
38:28-29
20 程勇前, 聂青和, 周永兴, 黄晓峰, 罗红, 杨华光. 透射电镜及激光共聚焦技术观察体外丙型肝炎病毒感染的人胎盘
滋养层细胞. 世界华人消化杂志 2003;11:151-156
21 聂青和, 王平忠, 周永兴. 丙型肝炎病毒感染孕妇羊水中丙型肝炎病毒RNA检测的临床意义. 中华妇产科杂志 2002;
, 百拇医药
37:19-21
22 Conte D, Fraquelli M, Prati D, Colucci A, Minola E. Prevalence and clinical course of chronic hepatitis C virus
(HCV) infection and rate of HCV vertical transmission in a cohort of 15, 250 pregnant women. Hepatology 2000;
31:751-755
23 Goncales FL Jr, Stucchi RS, Pavan MH, Angerami RN, Goncales NS. Hepatitis C virus in monozygotic twins. Rev Inst
, 百拇医药
Med Trop Sao Paulo 2000;42:163-165
24 Ruiz-Extremera A, Salmeron J, Torres C, De Rueda PM, Gimenez F, Robles C, Miranda MT. Follow-up of transmission
of hepatitis C to babies of human immunodeficiency virus-negative women: the role of breast-feeding in
transmission. Pediatr Infect Dis J 2000;19:511-516
25 Polywka S, Schroter M, Feucht HH, Zollner B, Laufs R. Low risk of vertical transmission of hepatitis C virus by breast
, 百拇医药
milk. Clin Infect Dis 1999;29:1327-1329
26 Mast EE. Mother-to-infant hepatitis C virus transmission and breastfeeding. Adv Exp Med Biol 2004;554:211-216
27 Conte D, Colucci A, Minola E, Fraquelli M, Prati D. Clinical course of pregnant women with chronic hepatitis C
virus infection and risk of mother-to-child hepatitis C virus transmission. Dig Liver Dis 2001;33:366-371
, http://www.100md.com
28 Okamoto M, Nagata I, Murakami J, Kaji S, Iitsuka T, Hoshika T, Matsuda R, Tazawa Y, Shiraki K, Hino S.
Prospective reevaluation of risk factors in mother-to-child transmission of hepatitis C virus: high virus load,vaginal delivery, and negative anti-NS4 antibody. J Infect Dis 2000;182:1511-1514
29 Kowala-Piaskowska A, Figlerowicz M, Mozer-Lisewska I, Mazur-Melewska K, Pawelek T, Sluzewski W.
, http://www.100md.com
Vertical transmission of hepatitis C virus infection. Hepatol Res 2004;30:137-140
30 Kumar RM, Frossad PM, Hughes PF. Seroprevalence and mother-to-infant transmission of hepatitis C in
asymptomatic Egyptian women. Eur J Obstet Gynecol Reprod Biol 1997;75:177-182
31 Azzari C, Resti M, Moriondo M, Ferrari R, Lionetti P, Vierucci A. Vertical transmission of HCV is related to
, 百拇医药
maternal peripheral blood mononuclear cell infection. Blood 2000;96:2045-2048
32 Spencer JD, Latt N, Beeby PJ, Collins E, Saunders JB, McCaughan GW, Cossart YE. Transmission of hepatitis C virus
to infants of human immunodeficiency virus-negative intravenous drug-using mothers: rate of infection and assessment
of risk factors for transmission. J Viral Hepat 1997;4:395-409
, 百拇医药
33 Healy CM, Cafferkey MT, Conroy A, Dooley S, Hall WW, Beckett M, Clarke TA, White MJ, Gorman WA, Butler KM.
Outcome of infants born to hepatitis C infected women. Ir J Med Sci 2001;170:103-106
34 聂青和, 李梦东. 丙型肝炎疫苗研究现状及策略. 中华流行病学杂志 1998;19:47-49
35 聂青和. 基因疫苗的基础研究及应用现状. 世界华人消化杂志 2003;11:125-129
36 Cheng PN, Chang TT, Jen CM, Ko AW, Young KC, Wu HL. Molecular evidence for transmission of GB virus-C/Hepatitis
, 百拇医药
G virus infection within family: close relationship between mother and child. Hepatogastroenterology 2003;50:151-156
37 程勇前, 聂青和. HBV、HCV垂直传播机制及预防研究近况. 实用肝脏病杂志 2003;6:182-185
38 Lima MP, Pedro RJ, Rocha MD. Mother-to-infant transmission of hepatitis C virus(HCV)in Brazil. J Trop
Pediatr 2004;50:236-238
39 罗新栋, 聂青和. 特殊人群的丙型肝炎特点及处理. 世界华人消化杂志 2004;12:2390-2395
, 百拇医药
40 李梦东, 聂青和. 进一步加强慢性丙型肝炎的临床实用性研究. 世界华人消化杂志 2004;12:2365-2368
41 Simpore J, Ilboudo D, Samandoulougou A, Guardo P, Castronovo P, Musumeci S. HCV and HIV co-infection in
pregnant women attending St. Camille Medical Centre in Ouagadougou (Burkina Faso). J Med Virol 2005;75:209-212
42 聂青和. 慢性丙型病毒性肝炎的诊断与治疗. 世界华人消化杂志 2004;12:2364-2409
编辑 张海宁, 百拇医药
