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随着国家免疫规划工作的推进和医疗卫生投入的不断提高,新发乙型肝炎病毒(HBV)感染大多属于母婴传播。在妊娠和生产过程中,尽管母亲采取核苷类似物和高效价免疫球蛋白联合进行阻断措施,新生儿也相继采取主、被动免疫等措施预防HBV母婴传播。然而,HBV感染的母婴阻断失败率仍然在15%~20%。这可能与胎盘屏障功能、外周血单核细胞感染及新生儿的遗传易感性等诸多方面因素有关,更有可能与HBV本身的分子进化有关[1-2]。不过,从分子进化的角度来看,病毒是如何适应体内外的环境变化,包括来自宿主体内的免疫压力和体外的抗病毒压力,使之从野生株进化为具有选择优势的病毒株的详细过程仍然不清楚。因此,本文仅就HBV
With the progress of the national immunization program and the increasing investment in health care, new-onset hepatitis B virus (HBV) infection mostly belongs to mother-to-child transmission. In pregnancy and production process, despite the mother to take nucleoside analogues and high titer of immunoglobulin blocking measures, newborns have also adopted the main, passive immunization and other measures to prevent mother-to-child transmission of HBV. However, the rate of failed maternal-infant blockage of HBV infection is still between 15% and 20%. This may be related to placental barrier function, peripheral blood mononuclear cell infection and neonatal genetic susceptibility and many other factors, more likely related to the molecular evolution of HBV itself [1-2]. However, from the perspective of molecular evolution, how the virus adapts to environmental changes both in vitro and in vivo, including the immunological pressure from the host and the antiviral stress in vitro, allows it to evolve from a wild-type strain to a more selective strain Still not clear. Therefore, this article only on HBV