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目的:探讨拉米夫定在妊娠不同时期使用的安全性及其与胎盘组织细胞凋亡的关系。方法:154例孕妇分为4组:非用药组、孕后期LAM组、全程LAM组和正常对照组。孕后期LAM组和全程LAM组所产新生儿均接受标准主被动联合免疫。观察宫内感染发生率,胎盘组织Bcl-2、Bax、HBcAg表达情况。结果:HBcAg(+)产妇胎盘组织Bax基因表达阳性率及表达强度均明显高于HBcAg(-)产妇,而Bcl-2基因表达阳性率及表达强度差异无统计学意义。拉米夫定的使用可降低HBsAg(+)孕妇宫内感染的发生率及胎盘组织HBcAg、Bax的表达,但对Bcl-2基因表达阳性率及表达强度无显著影响。结论:乙肝病毒宫内感染的发生可能与胎盘组织Bax基因表达增高有关;拉米夫定可能通过抑制乙肝病毒复制,减少其所诱导的Bax基因异常表达,导致胎盘组织凋亡减少,乙肝宫内感染发生率降低。
Objective: To investigate the safety of lamivudine in different stages of pregnancy and its relationship with the apoptosis of placental tissue. Methods: 154 pregnant women were divided into 4 groups: non-medication group, LAM group during pregnancy, LAM group and normal control group. Late pregnant LAM group and the entire LAM group of newborns received standard primary and secondary combined immunization. The incidence of intrauterine infection and the expression of Bcl-2, Bax and HBcAg in placenta were observed. Results: The positive rate and the expression of Bax gene in HBcAg (+) maternal placenta tissue were significantly higher than those in HBcAg (-) maternal group, but the positive rate and the expression intensity of Bcl-2 gene were not statistically significant. The use of lamivudine could reduce the incidence of intrauterine infection and the expression of HBcAg and Bax in HBsAg + pregnant women, but had no significant effect on the expression of Bcl-2 gene. Conclusion: The intrauterine infection of HBV may be related to the increase of Bax gene expression in placenta. Lamivudine may inhibit the expression of Bax gene and decrease the apoptosis of placenta, The incidence of infection is reduced.