乙肝病毒母婴传播危险因素及胎盘人白介素-6受体的研究
|
摘要
目的：①探讨HBV母婴垂直传播的危险因素；
②初步探索hIL-6和hIL-6R在胎盘组织的分布及其与胎盘感染HBV的关系。
方法：选取2004年10月至2006年10月在暨南大学附属第一医院妇产科产检和住院分娩的血清HBsAg阳性的孕产妇及其分娩的婴儿各318例为研究对象，收集孕期及产后的流行病学资料，采集孕产妇和婴儿的静脉血及产妇产后24小时内的乳汁检测乙肝病毒标志物(即乙肝病毒两对半和HBV-DNA)，同时收集分娩时胎盘组织进行研究。
①根据结果分感染组和非感染组，分析临床资料，筛选HBV母婴垂直传播的危险因素。
②采用酶联免疫吸附试验(ELISA)方法，检测血清HBsAg阳性的孕妇及其分娩的婴儿0、1、6月龄的静脉血，根据孕妇产前是否应用HBIG分为HBIG组和非HBIG组，分别比较两组婴儿HBV感染率。
③采用酶联免疫吸附试验(ELISA)方法，检测血清HBsAg阳性的孕妇及其分娩的婴儿的静脉血，根据分娩方式的不同分为顺产组和剖宫产组，比较两组婴儿HBV感染率。
④采用酶联免疫吸附试验(ELISA)方法和实时荧光定量PCR技术，检测血清HBsAg阳性的孕产妇血清、乳汁及所分娩的婴儿静脉血的乙肝病毒标志物，比较母亲血清HBV-M状态与母亲血清、乳汁的HBV-DNA阳性率的关系，并选取其中母亲乳汁HBsAg阳性，婴儿出生时HBsAg阴性的病例91例为研究对象，根据喂养方式的不同分母乳喂养组和人工喂养组，比较两组婴儿HBV感染率。
⑤免疫组化PV-9000法检测胎盘组织中HBsAg分布，分析胎盘组织中各层细胞的感染状况。
⑥免疫荧光双标记技术检测HBsAg阳性胎盘组织中HBsAg和hIL-6，激光共聚焦显微镜下观察两者的分布情况。
⑦免疫荧光双标记技术检测HBsAg阳性胎盘组织中HBsAg和hIL-6R，激光共聚焦显微镜下观察两者的分布情况。
结果：
①根据随访的结果，以六月龄时HBsAg阳性作为垂直感染的指标，感染组17例，非感染组301例，六月龄婴儿HBV母婴垂直传播率为5.35％，母血HBV-DNA、HBeAg阳性是HBV母婴垂直传播的危险因素。
②176例HBIG组(其中有25例应用HBIG＜3次)，142例非HBIG组，两组婴儿在1、6月龄时的HBV感染率差别有统计学意义(p＜0.05)，HBIG组低于非HBIG组。
③158例顺产组，132例剖宫产组，两组婴儿在0、6月龄时的HBV感染率差别具有统计学意义(p＜0.05)，剖宫产组低于顺产组。
④41例母乳喂养组，50例人工喂养组，两组婴儿各月龄HBV感染率差别无统计学意义(p＞0.05)。
⑤检测132例血清HBsAg阳性孕妇的胎盘，其中67例HBsAg阳性，胎盘HBV感染率为50.77％，免疫组化结果显示阳性信号位于胎盘组织中的各层细胞的胞浆和胞膜。
⑥免疫荧光双标记法检测胎盘组织中HBsAg和hIL-6，结果显示HBsAg和hIL-6存在于同一位置。
⑦胎盘组织从滋养层细胞、间质细胞至绒毛毛细血管内皮细胞有hIL-6R的表达。
⑧免疫荧光双标记法检测胎盘组织中HBsAg和hIL-6R，结果显示HBsAg和hIL-6R存在于同一位置。
结论：
①母血HBV-DNA、HBeAg阳性可能是HBV母婴垂直传播的危险因素。
②产前应用HBIG可有效降低HBV母婴垂直传播率。
③婴儿垂直感染HBV可能与分娩方式有关，与阴道顺产相比剖宫产可以降低HBV的母婴垂直传播率。
④婴儿感染HBV可能与喂养方式无关，在婴儿采取适当的免疫措施后，HBV携带产妇母乳喂养是安全的。
⑤HBV宫内感染可能存在经胎盘细胞表面hIL-6R介导的感染途径。
Objective:
1. To investigate the risk factors of hepatitis B virus (HBV) materno-fetal vertical transmission.
2. To investigate the distribution of hIL-6 and hIL-6R in placental tissue and the correlation between hIL-6、hIL-6R and placental HBV infection.
Methods:
318 cases of HBsAg positive pregnant women and their babies respectively, who were examined and laboured at the first affiliated Hospital of Ji Nan University, were studied. The epidemiologic informations of mothers and babies during pregnant period and after-born were collected. The peripheral blood hepatitis B virus markers (HBV-M) of the pregnant woman and their newborns, as well as the HBV markers detected in maternal milk within 24 hours after parturition, were collected. And the placenta tissues during parturition were collected for research.
1. According to the follow-up results, all cases were divided into either infection group or non-infection groups, the clinical datas were analyzed, and the risk factors of placental HBV infection were selected.
2. The HBV-M of peripheral blood in the pregnant woman and their newborns (0, 1, 6 months old) were detected by ELISA. The vertical HBV infection rates of the 2 newborn groups which applied and didn't applied HBIG were compared.
3. The peripheral blood in the pregnant woman and their newborns were detected by ELISA. According to the parturition manner, all cases were divided into either normal labour group or Caesarean birth group. The vertical HBV infection rates of the 2 newborn groups were compared.
4. The peripheral blood and milk of the HBsAg positive pregnant woman and the HBV-M of their newborns were detected by ELISA and Fluorescence Quantitative PCR (FQ-PCR). The correlation of maternal in the HBV-M situation and HBV-M positive rate of milk were analyzed. 91 HBsAg negative newborns, whose mothers' milk were HBsAg positive, were selected. According to the different feeding manner, these 91 cases were divided into either mother-milk feed group or manpower feed group, the neonatal infection rates of these 2 groups were compared.
5. Immunohistochemical staining PV-9000 was applied to detect HBsAg in placentas and analyze the HBsAg positive rate of cells in every layer of them.
6. HBsAg and hIL-6 in the HBsAg positive placenta tissue were detected by double-label immunofluorescence assays and their distributions were observed by the confocal laser scanning technique.
7. HBsAg and hIL-6R in the HBsAg positive placenta tissue were detected by double-label immunofluorescence assays and their distributions were observed by the confocal laser scanning technique.
Results:
1. The follow-up results of infants showed that, using the HBsAg positive at 6-month infants as a diagnostic criteria for intrauterine HBV infection, infection group had 17 cases, non-infection group had 301 cases, and the rate of placental HBV infection was 5.35%. Maternal serum HBV-DNA positive, HBeAg positive were the risk factors of placental HBV infection.
2. 176 cases that applied HBIG (among them which 25 cases applied HBIG＜3 times), 142 cases that didn't apply HBIG. There is a significant difference between these 2 groups in HBsAg positive rate of one-month and six-month old infant (P＜0.05).
3. There are 158 cases of normal labour group and 132 cases of Caesarean birth group. There is a significant difference between these 2 groups in HBsAg positive rate of zero-month and six-month old infant (P＜0.05).
4. There are 41 cases of mother-milk feed group and 50 cases of manpower feed group. No significant difference existed between these 2 infant groups in the HBsAg positive rate of zero-month、one-month and six-month old infant P＞0.05).
5. There were 67 HBsAg positive placentas in 132 HBsAg positive pregnant women (the positive rate was 50.77%). The immunohistochemical result showed that there is a positive signal in the cell plasm and membrane of every layer of the placental tissue.
6. Double-label immunofluorescence assays and the confocal laser scanning technique showed that HBsAg and hIL-6 existed in the same position of placental tissue.
7. The positive signal of hIL-6R was indicated by trophoblastic cells, villous mesenchymal cells and vascular endothelial cells of placental tissue.
8. Double-label immunofluorescence assays and the confocal laser scanning technique showed that HBsAg and hIL-6R existed in the same position of placental tissue.
Conclusion:
1. Maternal serum HBV-DNA、positive HBeAg and parturition manners are high risk factors of HBV materno-fetal vertical transmission.
2. Applying HBIG takes effects lower the rate of blocking the HBV vertical transmission.
3. The parturition manners are related with the placental HBV infection of infants. Compared with normal labour, Caesarean birth may reduce the the rate of HBV materno-fetal vertical transmission.
4. The HBV infection of infants could be nothing to do with the feeding manners. Feeding by HBV positive lying-in women will be safe if proper immunity protection measures are used.
5. The route of infection mediated by hIL-6R on placental cells maybe exists in placental HBV infection.
②初步探索hIL-6和hIL-6R在胎盘组织的分布及其与胎盘感染HBV的关系。
方法：选取2004年10月至2006年10月在暨南大学附属第一医院妇产科产检和住院分娩的血清HBsAg阳性的孕产妇及其分娩的婴儿各318例为研究对象，收集孕期及产后的流行病学资料，采集孕产妇和婴儿的静脉血及产妇产后24小时内的乳汁检测乙肝病毒标志物(即乙肝病毒两对半和HBV-DNA)，同时收集分娩时胎盘组织进行研究。
①根据结果分感染组和非感染组，分析临床资料，筛选HBV母婴垂直传播的危险因素。
②采用酶联免疫吸附试验(ELISA)方法，检测血清HBsAg阳性的孕妇及其分娩的婴儿0、1、6月龄的静脉血，根据孕妇产前是否应用HBIG分为HBIG组和非HBIG组，分别比较两组婴儿HBV感染率。
③采用酶联免疫吸附试验(ELISA)方法，检测血清HBsAg阳性的孕妇及其分娩的婴儿的静脉血，根据分娩方式的不同分为顺产组和剖宫产组，比较两组婴儿HBV感染率。
④采用酶联免疫吸附试验(ELISA)方法和实时荧光定量PCR技术，检测血清HBsAg阳性的孕产妇血清、乳汁及所分娩的婴儿静脉血的乙肝病毒标志物，比较母亲血清HBV-M状态与母亲血清、乳汁的HBV-DNA阳性率的关系，并选取其中母亲乳汁HBsAg阳性，婴儿出生时HBsAg阴性的病例91例为研究对象，根据喂养方式的不同分母乳喂养组和人工喂养组，比较两组婴儿HBV感染率。
⑤免疫组化PV-9000法检测胎盘组织中HBsAg分布，分析胎盘组织中各层细胞的感染状况。
⑥免疫荧光双标记技术检测HBsAg阳性胎盘组织中HBsAg和hIL-6，激光共聚焦显微镜下观察两者的分布情况。
⑦免疫荧光双标记技术检测HBsAg阳性胎盘组织中HBsAg和hIL-6R，激光共聚焦显微镜下观察两者的分布情况。
结果：
①根据随访的结果，以六月龄时HBsAg阳性作为垂直感染的指标，感染组17例，非感染组301例，六月龄婴儿HBV母婴垂直传播率为5.35％，母血HBV-DNA、HBeAg阳性是HBV母婴垂直传播的危险因素。
②176例HBIG组(其中有25例应用HBIG＜3次)，142例非HBIG组，两组婴儿在1、6月龄时的HBV感染率差别有统计学意义(p＜0.05)，HBIG组低于非HBIG组。
③158例顺产组，132例剖宫产组，两组婴儿在0、6月龄时的HBV感染率差别具有统计学意义(p＜0.05)，剖宫产组低于顺产组。
④41例母乳喂养组，50例人工喂养组，两组婴儿各月龄HBV感染率差别无统计学意义(p＞0.05)。
⑤检测132例血清HBsAg阳性孕妇的胎盘，其中67例HBsAg阳性，胎盘HBV感染率为50.77％，免疫组化结果显示阳性信号位于胎盘组织中的各层细胞的胞浆和胞膜。
⑥免疫荧光双标记法检测胎盘组织中HBsAg和hIL-6，结果显示HBsAg和hIL-6存在于同一位置。
⑦胎盘组织从滋养层细胞、间质细胞至绒毛毛细血管内皮细胞有hIL-6R的表达。
⑧免疫荧光双标记法检测胎盘组织中HBsAg和hIL-6R，结果显示HBsAg和hIL-6R存在于同一位置。
结论：
①母血HBV-DNA、HBeAg阳性可能是HBV母婴垂直传播的危险因素。
②产前应用HBIG可有效降低HBV母婴垂直传播率。
③婴儿垂直感染HBV可能与分娩方式有关，与阴道顺产相比剖宫产可以降低HBV的母婴垂直传播率。
④婴儿感染HBV可能与喂养方式无关，在婴儿采取适当的免疫措施后，HBV携带产妇母乳喂养是安全的。
⑤HBV宫内感染可能存在经胎盘细胞表面hIL-6R介导的感染途径。
Objective:
1. To investigate the risk factors of hepatitis B virus (HBV) materno-fetal vertical transmission.
2. To investigate the distribution of hIL-6 and hIL-6R in placental tissue and the correlation between hIL-6、hIL-6R and placental HBV infection.
Methods:
318 cases of HBsAg positive pregnant women and their babies respectively, who were examined and laboured at the first affiliated Hospital of Ji Nan University, were studied. The epidemiologic informations of mothers and babies during pregnant period and after-born were collected. The peripheral blood hepatitis B virus markers (HBV-M) of the pregnant woman and their newborns, as well as the HBV markers detected in maternal milk within 24 hours after parturition, were collected. And the placenta tissues during parturition were collected for research.
1. According to the follow-up results, all cases were divided into either infection group or non-infection groups, the clinical datas were analyzed, and the risk factors of placental HBV infection were selected.
2. The HBV-M of peripheral blood in the pregnant woman and their newborns (0, 1, 6 months old) were detected by ELISA. The vertical HBV infection rates of the 2 newborn groups which applied and didn't applied HBIG were compared.
3. The peripheral blood in the pregnant woman and their newborns were detected by ELISA. According to the parturition manner, all cases were divided into either normal labour group or Caesarean birth group. The vertical HBV infection rates of the 2 newborn groups were compared.
4. The peripheral blood and milk of the HBsAg positive pregnant woman and the HBV-M of their newborns were detected by ELISA and Fluorescence Quantitative PCR (FQ-PCR). The correlation of maternal in the HBV-M situation and HBV-M positive rate of milk were analyzed. 91 HBsAg negative newborns, whose mothers' milk were HBsAg positive, were selected. According to the different feeding manner, these 91 cases were divided into either mother-milk feed group or manpower feed group, the neonatal infection rates of these 2 groups were compared.
5. Immunohistochemical staining PV-9000 was applied to detect HBsAg in placentas and analyze the HBsAg positive rate of cells in every layer of them.
6. HBsAg and hIL-6 in the HBsAg positive placenta tissue were detected by double-label immunofluorescence assays and their distributions were observed by the confocal laser scanning technique.
7. HBsAg and hIL-6R in the HBsAg positive placenta tissue were detected by double-label immunofluorescence assays and their distributions were observed by the confocal laser scanning technique.
Results:
1. The follow-up results of infants showed that, using the HBsAg positive at 6-month infants as a diagnostic criteria for intrauterine HBV infection, infection group had 17 cases, non-infection group had 301 cases, and the rate of placental HBV infection was 5.35%. Maternal serum HBV-DNA positive, HBeAg positive were the risk factors of placental HBV infection.
2. 176 cases that applied HBIG (among them which 25 cases applied HBIG＜3 times), 142 cases that didn't apply HBIG. There is a significant difference between these 2 groups in HBsAg positive rate of one-month and six-month old infant (P＜0.05).
3. There are 158 cases of normal labour group and 132 cases of Caesarean birth group. There is a significant difference between these 2 groups in HBsAg positive rate of zero-month and six-month old infant (P＜0.05).
4. There are 41 cases of mother-milk feed group and 50 cases of manpower feed group. No significant difference existed between these 2 infant groups in the HBsAg positive rate of zero-month、one-month and six-month old infant P＞0.05).
5. There were 67 HBsAg positive placentas in 132 HBsAg positive pregnant women (the positive rate was 50.77%). The immunohistochemical result showed that there is a positive signal in the cell plasm and membrane of every layer of the placental tissue.
6. Double-label immunofluorescence assays and the confocal laser scanning technique showed that HBsAg and hIL-6 existed in the same position of placental tissue.
7. The positive signal of hIL-6R was indicated by trophoblastic cells, villous mesenchymal cells and vascular endothelial cells of placental tissue.
8. Double-label immunofluorescence assays and the confocal laser scanning technique showed that HBsAg and hIL-6R existed in the same position of placental tissue.
Conclusion:
1. Maternal serum HBV-DNA、positive HBeAg and parturition manners are high risk factors of HBV materno-fetal vertical transmission.
2. Applying HBIG takes effects lower the rate of blocking the HBV vertical transmission.
3. The parturition manners are related with the placental HBV infection of infants. Compared with normal labour, Caesarean birth may reduce the the rate of HBV materno-fetal vertical transmission.
4. The HBV infection of infants could be nothing to do with the feeding manners. Feeding by HBV positive lying-in women will be safe if proper immunity protection measures are used.
5. The route of infection mediated by hIL-6R on placental cells maybe exists in placental HBV infection.
引文
[1]Ocama P, Opio CK, Lee WM. Hepatitis B vires infection: current status. Am J Med,2005, 118(12):1413.
[2]Yao JL. Perinatal transmission of hepatitis B vires infection and vaccination in China. Gut, 1996, 38(s2):S37-38.
[3]贾继东，庄辉．中国慢性乙型肝炎治疗进展研讨会会议纪要．中华肝脏病杂志，2004，12(11)：698-699．
[4]周维霞，李加新，魏立，等．乙肝病毒母婴宫内垂直传播的探讨和预防[J]．标记免疫分析与临床，2004，11(2)：116-117．
[5]Zhang SL,Han XB,Yue YF, Relationship between HBV viremia level of pregnant women and intrauterine infection; neated PCR for detection of HNV DNA[J].World J Gastroenterd, 1998,4(1):61-63.
[6]Wang Z,Zhang J,Yang H,et al.Quantitativeanalysis sof HBV DNA Aleveland HBeAg titerin HBsAg positive mothers and their babies: HbsAg passage through the placenta and the rate of dacey in babies.J Med Virol,2003,71 (3):360-366.
[7]Wang JS,Zhu QR,Zhang XZ. Infection of the fetus with hepatitis B antigen via the placenta.Lancet,2000,9208(355):989-970.
[8]Burk RD,H wang LY, Ho GY, et al.Outcome of perinatal hepatitis B virus exposure is dependent on maternal virusload.J Infect Dis, 1994,170(12):1418-1423.
[9]徐德忠，闫永平，徐剑秋，王文亮，门可，张景霞，刘斌，刘志华，王福生，蒋美玲，陈向红．乙型肝炎病毒宫内传播因素和机制的分子流行病学研究[J]．中华医学杂志，1999，1(29)：24-27．
[10]门可，徐剑秋．乙肝免疫球蛋白阻断乙肝宫内传播的研究[J]．中国公共卫生，2003，19(7)：775-776．
[11]Milich D, Liang TJ. Exploring the biological basis of hepatitis B e antigen in hepatitis B virus infection. Hepatology, 2003, 38(5):1075-1086.
[12]刘志华，徐德忠，闫永平，等．孕妇血清中乙型肝炎病毒DNA含量与胎儿宫内感染的关系．中华妇产科杂志，1999，34(3)：133．
[13]闫永平，徐德忠，王文亮，刘斌，张景霞，刘志华，门可，徐剑秋，李远贵．HBsAg阳性孕妇足月分娩胎盘HBV感染状态的免疫组织化学研究．第四军医大学学报，1997,18(5)：409-411．
[14]Ohto H,Lin H,Kanawa T, et al.intrauterine transmission of hepatitis B vires is closely related to placental leakage[J].J Med Virol, 1987,21(1):1-6.
[15]刘志华，徐德忠，闫永平，等．乙型肝炎病毒宫内感染危险因素的病例对照研究[J]．中国公共卫生学报，1997，16(5)：265-266．
[16]常文辉，闫永平，门可，杜可军，邵中军，万毅，王雪(?)，徐勇勇，徐德忠．HBV宫内传播危险因素德Meta分析．第四军医大学学报．2003；24(24)：2290-2292．
[17]唐时幸，于光烈，程绍尧．乙肝病毒宫内感染机制及影响因素的研究，中华流行病学杂志，1991；12：60：325-326
[18]闫永平，徐德忠，王文亮，等．胎盘乙型肝炎病毒感染与宫内传播的关系[J]，中华妇产科杂志，1999,34(7)：392-394．
[19]闫永平，徐德忠，王福生，门可，刘志华，乙型肝炎病毒宫内感染的机制[J]，第四军医大学学报,2001,22(6)：548-550．
[20]王素萍，徐德忠，李远贵，闫永平，门可，张景霞，HBsAg进入体外培养的人绒毛膜滋养层细胞的初步研究[J]，第一军医大学学报,2003,23(1)：16-20．
[21]Badur S,Lazizi Y.Transplacental passage of hepatitis B virus DNA from hepatitis B eantigen-negative mothers and delayde immune resonse in newborns[J].J Infect Dis, 1994,169:704-706.
[22]王健，孙琳。HBV垂直传播的细胞分子机制研究[J]．实用医学杂志．2001，17(9)：826-827．
[23]黄醒华．必须重视妊娠合并病毒性肝炎[J]．中国实用妇科与产科杂志，2004，20(2)：65．
[24]Lin HH, Kao JH, Hsu HY, et al.Least microtransfusion From Mother to Fetus in Elective Cesarean Delivery.Obstet Gynecol, 1996, 87:244-248.
[25]王清图，修霞，郭永，等．不同方案阻断乙肝病毒母婴传播的临床研究[J]．临床肝胆病杂志,2002,18(1)：51-52．
[26]Wang JS,Zhu QR,Zhang XZ. Effect of delivery mode on maternal-infant transmission of hepatitis B virus by immunoprophylaxis.Chinese Medical Journal,2002, 115(10):1510-1512.
[27]钱燕华．分娩方式对乙型肝炎母婴传播阻断效果的影响[J]．职业与健康,2006,22(17)：1332-1334．
[28]马力，赵桂珍，曲以琴，等．HBV携带产妇的婴儿乙肝基因疫苗免疫后母乳喂养安全性的研究[J]．中国公共卫生杂志，2000，16(3)：269-270．
[29]黄建宏，林心，林瑞贞，冯小三，等．HBV感染产妇乳汁中乙肝病毒标志物检测分析．国外医学临床生物化学与检验学册,2005,26(5)：271-272．
[30]杨晓，崔敏娴，刘保根．乙型肝炎血清学指标阳性母亲哺乳问题的研究．中华妇产科杂志，1994,29(10)：586．
[31]Wu M Ingm Ing, Tang Yinrong, Guo Ca Iyu, et al. The result observation of HBV carried lying-in women who has been taken the measure of interdiction [J]. China J Obstet Gynecol, 2002, 37:235-236.
[32]姚琦玮，李敦华，陈颖，等．联合免疫后HBV携带者母乳喂养的安全性研究．中国实用妇科与产科杂志,2004,20(2)：109～110．
[33]陈勇峰。乙型肝炎病毒与母乳喂养．中国实用妇科与产科杂志，1997，13(2)：676-677．
[34]朱启镕，吕晴，俞惠，等．宫内感染HBV婴儿接种乙肝疫苗免疫失败的机理和预后研究[J]．中华儿科杂志，1997,35：349-352．
[35]曾义岚，吴俭，王丽，胡蓉，卜惠敏，朱丽新．乙型肝炎病毒血清学复制指标阳性产妇哺乳安全性探讨[J]．四川医学,2003,24(8)：823-824．
[36]蒋丽霞，郑奎,王荣华，等．乙肝免疫球蛋白在预防HBV宫内感染中的作用[J]．中国现代医学杂志,2002,21(12)：85-86．
[37]刘海英，马玉燕，崔保霞，戴(曰文)笙，杨洁．孕妇乙肝免疫球蛋白被动免疫阻断HBV母婴垂直传播作用机理的研究[J]．现代妇产科进展,2002,11(2)：128-130．
[38]洪善玲，王波君，孙佰风，赵琰清，殷桂云，赵晶晶．早孕期应用HBIG阻断乙肝母婴垂直传播、乳汁传播的临床研究[J]．医药产业资讯，2006，15(3)：15-16．
[39]Xiao XM, Li AZ, Chen X, Zhu YK, Miao J.Prevention of vertical hepatitis B transmission by hepatitis B immunoglobulin in the third trimester of pregnancy. Int J Gynaecol Obstet. 2007 Mar;96(3):167-70.
[40]朱科伦，马佩球，张为民，等．HBV阳性孕妇接种乙肝免疫球蛋白后免疫学反应的研究[J]．广州医药，2004，35(1)：1-2．
[41]郭永，王建芹，李萌萌，等．孕期干预阻断乙肝病毒母婴垂直传播的结果分析[J]．中国优生与遗传杂志,2005,13(2)：78-79．
[42]Van Nunen AB,De Man RB,Heijtink RA,et al.Lamivudine in the last 4 weeks of pregnancy to prevent perinatal transmission in hightly viremie chronic hepatitis B patients[J].J Hepatol,2000,32(6):1040-1041.
[43]韩忠厚，陈妍华，苏雪松，等．拉米夫定联合主被动免疫阻断乙型肝炎病毒母婴垂直传播[J]．河北医药，2005,27(1)：23-24．
[44]Kazim SN,Wakil SM,Khan LA,et al.Vertical transmission of hepatitis B virusdespite maternal lamivudine therapy[J].Lancet,2002,359(9316):1488-1499.
[45]王家祥，郭晓华，张燕，等．解毒复肝灵抑制乙肝病毒母婴宫内传播的临床观察[J]．中国中西医结合杂志,2003,23(4)：310-311．
[46]纪向虹，戚红．不同分娩方式对HBV母婴传播的影响[J]．山东医药,2002,42(15)：18-19．
[47]李红，王中弥，黄燕，等．乙肝免疫球蛋白阻断母婴传播机制的研究[J]．中国优生与遗传杂志，2002,10(4)：68-69．
[48]徐德忠，闫永平，王素萍，刘蓬勃，白钢钻，王歆，史梦远，王雪萍，胎盘组织在乙型肝炎病毒宫内传播中的作用及其机制研究[J]，中华医学杂志,2001，3(81)：176-177．
[49]郦爱贞，肖小敏，陈新，吴莉莉，路妍妍，FcγRⅢ在乙型肝炎病毒胎盘感染中作用的研究[J]．中国优生与遗传杂志,2006,14(5)：59-60．
[50]曹宝花，门可，徐德忠，闫永平，张景霞，王文勇．探讨HBsAg/Annexin V检测在HBV宫内传播中的意义[J]．第四军医大学学报，2004；25(7)：581-583．
[51]Lin HH,Lee Y, Chen DS,Sung JL,Ohto H,Etoh T, Kawana T, Mizuno M.Transplacental leakage of HbeAg-positive maternal blood as the most likely route in causing intrauterine infection with hepatitis B virus.[J]Pediatr, 1987,111(6):877-881.
[52]Xu DZ, Yan YP, Choi BC, Xu JQ, Men K, Zhang JX, Liu ZH, Wang FS. Risk factors and mechanism of transplacental transmission of hepatitis B virus: a case-control study. J Med Virol, 2002,67(1):20-26.
[53]王素萍，徐德忠，闫永平，等．乙型肝炎病毒宫内传播危险因素的研究．中国公共卫生学报．1999，18(4)：251-252．
[54] Stoll-Becker, Repp R,Glebe D,et al .Transcription of hepatitis B virus in periphdral blood mononuclear cells from persistently infection patients[J].J Virol, 1997,71(7):5399-5407.
[55] 魏俊妮，王素萍，等．乙型肝炎病毒宫内感染的细胞分子机制[J]．代预防医学杂志，2005，32(2)：94-95．
[56] 门可，徐德忠，闫永平，等．血HBsAg，HbeAg阳性孕妇外周血单个核细胞HBV感染的研究．中华妇产科杂志．1996，31(10)：597-599．
[57] Hadchouel M, Scotto J, Huret JL, Molinie C, Villa E, Degos F, Brechot C. Presence of HBV-DNA in spermatozoa: a possible vertical transmission of HBV via the germ line. J Med Virol, 1985, 16(1):61-66.
[58] Taylor PJ, Gill MJ, Mahadevan M, Pattinson HA. Hepatitis B virus in human follicular fluid. Fertil Steril, 1987, 48(3):514.
[59] Huang J M,Huang T H,Qiu H Y, et al.Studies on the integration of heptitis B virus DNA sequence in human sperm chromo somes[J].Asian J Androl,2002,4(3):209-212.
[60] Zenclussen AC,Blois S,Stumpo R,Olmos S,Arias K,Malan Borel I,Roux ME,Margni RA.Murine abortion is associated with enhanced interleukin-6 levels at the feto-matemal interface.Cytokine,2003,21,24(4):150-60.
[61] Deb S,Tessier C,Prigent-Tessier A,Barkai U,Ferguson-Gottschall S,Srivastava RK,Faliszek J,Gibori G.The expression of interleukin-6 (IL-6), IL-6 receptor, and gp130-kilodalton glycoprotein in the rat decidua and a decidual cell line: regulation by 17beta-estradiol and prolactin. Endocrinology. 1999,140(10):4442-50.
[62] Dame JB,Juul SE,The distribution of receptors for the pro-inflammatory cytokines interleukin (IL)-6 and IL-8 in the developing human fetus.Early Hum Dev,2000,58(1):25-39.
[63] Steinborn A,Geisse M,Kaufmann M.Expression of cytokine receptors in the placenta in term and preterm labour.Placenta. 1998,19(2-3):165-70.
[64] Neurath AR,Strick N,Li yy.Cells transfeeted with human interleukin-6 cDNA acquire binding sites for the hepatitis B virus envelope protein.J ExpMed, 1992,176(6):1561-1569.
[65] Galun E, Nahor O, Eid A, Jurim O, Rose-John S, Blum HE, Nussbaum O,Ilan E, Daudi N,Shouval D,Reisner Y, Dagan S.Human interleukin-6 Facilitates hepatitis B virus infection in vitro and in vivo.Virology,2000,270(2):299-309.
[66]Heinz D,Peters M,Prange Gerken G, Rose-John S.Possible role of human interleukin-6 and soluble interleukin-6 receptor in hepatitis B virus infection.J Viral Hepat, 2001,8(3):186-193.
[67]李铁钢，王素萍．胎盘组织在HBV宫内感染中的作用．中国优秀博硕士论文．2004．
[68]王素萍，徐德忠．乙型肝炎病毒宫内感染的研究现状及今后工作重点[J]．中华流行病学杂志,2005,26(4)：229-231．
[69]Huang K,Lin S.Nation wide vaccination: A successstory in Taiwan[J].Vaccine,2000,18(Supp1):35-38.
[70]尚涛．乙型肝炎病毒的母婴传播及预防．中国实用妇科与产科杂志，2001，17(6)：330-332．
[71]王建设，朱启镕．阻断乙型肝炎病毒母婴传播的研究进展．中华肝脏病志,2002,10(4)：308-310．
[72]郦爱贞，肖小敏，乙肝病毒宫内感染临床诊断标准的探讨[J]．中国妇幼保健,2007,22(4)：475-477．
[73]Vranckx R, Alisjahbana A, Meheus A. Hepatitis B virus vaccination and antenatal transmission of HBV markers to neonates. J Viral Hepat,1999,6(2):135-139.
[74]陈灵，吴小红，李静．妊娠合并乙型肝炎宫内感染及对策．中国妇幼保健,2004,19(10)：74-75．
[75]骆抗先主编．乙型肝炎—基础和临床.北京：人民卫生出版社，1997,233．
[76]朱启镕，于广军，吕晴，俞蕙，顾新焕，张秀珍，董左权．阻断乙型肝炎病毒宫内传播的随机对照研究[J]．中华儿科杂志,2002,40(8)：478-480．
[77]王丽峰，杨岚，邱文山，杨冬，乙肝表面抗原阳性孕妇肌注乙肝免疫球蛋白预防母婴传播的效果[J]．广东医学,2006,27(6)：898-899．
[78]肖小敏，陈新，李耘，叶志海，何明娇，徐玉苑．HBsAg阳性孕妇产前应用乙型肝炎免疫球蛋白提高婴儿对乙型肝炎疫苗的免疫反应[J]．新医学,2005,10(36)：567-569．
[79]徐德忠，闫永平，徐剑秋，等．乙型肝炎病毒宫内传播机制的分子流行病学研究[J]．中华流行病学杂志，1998,19(3)：131-133．
[80]Beasley RP, Trepo C,Stevens CE,et al.Thee antigen and vertical transmission of hepatitis B surface antigen[J].Am J Epidemiol, 1977,105(2):94-98.
[81]Kadak,Kamiyama I,Inomata M,et al.Eantigen and antiein theserum of asymptomatic carder mothers as in dicator sofpositive and negative transmission of hepatitis B virus to tue irinfants[J].N Eng I J Med, 1976,294(14):746-749.
[82]Bertoletti A,Maini MK. Protection or damage:adual role for the virus specific cytotoxin Tlym phocyte response in hepatitis B and Cinfection?Curr Opin Microbiol,2000,3(4):387-392.
[83]崔恒春，闫永平，邵中军，徐德忠，门可，徐剑秋，李军，免疫预防后HBeAg与HBV宫内感染分析[J]．中国公共卫生,2006,22(7)：824-826．
[84]尚涛．乙型肝炎病毒的母婴传播及预防．中国实用妇科与产科杂志，2001，17(6)：330．
[85]马宁生，朱敏，应红华，林益平．孕妇产前进行免疫阻断与新生儿乙型肝炎基因疫苗免疫效果关系的研究[J]．中国实用儿科杂志,2006,21(1)：29-31．
[86]Lee SD,Lo KJ,Tsai YT, et al.Role of caesarena section in prevention of mother-infant transmission of hepatitis B vires.Lancet,1988,2(8615):833-834.
[87]Hill JB, Sheffield JS, Kim M J, Alexander JM, Sercely B, Wendel GD._Risk of hepatitis B transmission in breast-fed infants of chronic hepatitis B carriers.Obstet Gynecol. 2002,99(6):1049-1052.
[88]陈慧文，郭悦青，陈旭，温国明，徐明锐，叶关泉．产妇携带乙肝病毒对哺乳影响的研究[J]．数理医药学杂志,2004,17(5)：411-413．
[89]孟钊，肖小敏，何明娇，徐玉苑，李耘．乙肝病毒携带产妇HBIG应用及不同喂养方式对婴儿的影响[J]．实用医学杂志,2004,20(10)：1102-1104．
[90]姚琦玮，李敦华，陈颖，黄夏娣．联合免疫后HBV携带者母乳喂养的安全性研究[J]．中国实用妇科与产科杂志,2004,20(2)：109-110．
[91]牟瑞丽，马玉燕，李桦，孔北华，江森．乙型肝炎病毒携带者母乳喂养的研究[J]．中华围产医学杂志,2005,8(1)：20-23．
[92]王元，何成章，黄文琴，蔡祥莺，姚建敏．联合免疫后乙肝病毒母婴传播相关因素的临床研究[J]．中国妇幼保健,2005,20(13)：1655-1657．
[93]张惠忠，马明孝，李霞，田美晴．304例阻断HBV母婴传播效果观察[J]．中西医结合肝病杂志,2005,15(5)：289-290．
[94]冯松婉，江玲娟．乙肝表面抗原阳性产妇婴儿喂养方式探讨[J]．中国农村卫生事业管理,2005,25(4)：63．
[95]安玉香，白洁，韩美俊，杨桂生，马广慈，申伟．174例HBsAg阳性产妇婴儿母乳喂养与人工喂养HBV感染情况对比[J]．中国初级卫生保健，1995,9(9)：38．
[96]王小青，刘亦琪，孙亦骏，蒋涛，吴斌．母乳喂养传播乙型肝炎病毒的临床研究[J]．江苏医药，1996,22(12)：827-828．
[97]马力，赵桂珍，曲以琴，梁争伦，吴小音，钟熙．HBV携带产妇的婴儿乙肝基因疫苗免疫后母乳喂养安全性的研究[J]．中国公共卫生,2000,16(3)：269-270．
[98]曾文铤，朱科伦，马佩球，邓志校，卫建筠，叶新民．母乳喂养与乙型肝炎病毒传播的临床研究[J]．中西医结合肝病杂志,2001，11(1)：13-14．
[99]陈涛，相龙云，彭华彬，赵金凤．产妇乙肝病毒感染者血清及乳汁中HBV-DNA定量检测分析[J]．现代医药卫生,2006,22(12)：1880-81．
[100]孟钊，肖小敏，何明娇，徐玉苑，李耘．乙肝病毒携带产妇HBIG应用及不同喂养方式对婴儿的影响[J]．实用医学杂志,2004,20(10)：1102-1104．
[101]Hill JB, Sheffield JS, Kim MJ, Alexander JM, Sercely B, Wendel GD._Risk of hepatitis B transmission in breast-fed infants of chronic hepatitis B carriers.Obstet Gynecol.2002;99(6):1049-52.
[102]王建设，朱启镕，张公惠，费林娥．母乳喂养不影响乙型肝炎病毒母婴传播阻断效果[J]．中华围产医学杂志,2003,6(1)：24-27．
[103]陈宏．死胎胎盘组织中HBV-DNA测定及意义[J]．山东医药,2002,42(3)：53．
[104]晏路标，肖昕，熊爱华．胎盘Hofbauer细胞在乙型肝炎病毒母婴垂直传播中的作用[J]．实用儿科临床杂志,2006,21(6)：351-358．
[2]Yao JL. Perinatal transmission of hepatitis B vires infection and vaccination in China. Gut, 1996, 38(s2):S37-38.
[3]贾继东，庄辉．中国慢性乙型肝炎治疗进展研讨会会议纪要．中华肝脏病杂志，2004，12(11)：698-699．
[4]周维霞，李加新，魏立，等．乙肝病毒母婴宫内垂直传播的探讨和预防[J]．标记免疫分析与临床，2004，11(2)：116-117．
[5]Zhang SL,Han XB,Yue YF, Relationship between HBV viremia level of pregnant women and intrauterine infection; neated PCR for detection of HNV DNA[J].World J Gastroenterd, 1998,4(1):61-63.
[6]Wang Z,Zhang J,Yang H,et al.Quantitativeanalysis sof HBV DNA Aleveland HBeAg titerin HBsAg positive mothers and their babies: HbsAg passage through the placenta and the rate of dacey in babies.J Med Virol,2003,71 (3):360-366.
[7]Wang JS,Zhu QR,Zhang XZ. Infection of the fetus with hepatitis B antigen via the placenta.Lancet,2000,9208(355):989-970.
[8]Burk RD,H wang LY, Ho GY, et al.Outcome of perinatal hepatitis B virus exposure is dependent on maternal virusload.J Infect Dis, 1994,170(12):1418-1423.
[9]徐德忠，闫永平，徐剑秋，王文亮，门可，张景霞，刘斌，刘志华，王福生，蒋美玲，陈向红．乙型肝炎病毒宫内传播因素和机制的分子流行病学研究[J]．中华医学杂志，1999，1(29)：24-27．
[10]门可，徐剑秋．乙肝免疫球蛋白阻断乙肝宫内传播的研究[J]．中国公共卫生，2003，19(7)：775-776．
[11]Milich D, Liang TJ. Exploring the biological basis of hepatitis B e antigen in hepatitis B virus infection. Hepatology, 2003, 38(5):1075-1086.
[12]刘志华，徐德忠，闫永平，等．孕妇血清中乙型肝炎病毒DNA含量与胎儿宫内感染的关系．中华妇产科杂志，1999，34(3)：133．
[13]闫永平，徐德忠，王文亮，刘斌，张景霞，刘志华，门可，徐剑秋，李远贵．HBsAg阳性孕妇足月分娩胎盘HBV感染状态的免疫组织化学研究．第四军医大学学报，1997,18(5)：409-411．
[14]Ohto H,Lin H,Kanawa T, et al.intrauterine transmission of hepatitis B vires is closely related to placental leakage[J].J Med Virol, 1987,21(1):1-6.
[15]刘志华，徐德忠，闫永平，等．乙型肝炎病毒宫内感染危险因素的病例对照研究[J]．中国公共卫生学报，1997，16(5)：265-266．
[16]常文辉，闫永平，门可，杜可军，邵中军，万毅，王雪(?)，徐勇勇，徐德忠．HBV宫内传播危险因素德Meta分析．第四军医大学学报．2003；24(24)：2290-2292．
[17]唐时幸，于光烈，程绍尧．乙肝病毒宫内感染机制及影响因素的研究，中华流行病学杂志，1991；12：60：325-326
[18]闫永平，徐德忠，王文亮，等．胎盘乙型肝炎病毒感染与宫内传播的关系[J]，中华妇产科杂志，1999,34(7)：392-394．
[19]闫永平，徐德忠，王福生，门可，刘志华，乙型肝炎病毒宫内感染的机制[J]，第四军医大学学报,2001,22(6)：548-550．
[20]王素萍，徐德忠，李远贵，闫永平，门可，张景霞，HBsAg进入体外培养的人绒毛膜滋养层细胞的初步研究[J]，第一军医大学学报,2003,23(1)：16-20．
[21]Badur S,Lazizi Y.Transplacental passage of hepatitis B virus DNA from hepatitis B eantigen-negative mothers and delayde immune resonse in newborns[J].J Infect Dis, 1994,169:704-706.
[22]王健，孙琳。HBV垂直传播的细胞分子机制研究[J]．实用医学杂志．2001，17(9)：826-827．
[23]黄醒华．必须重视妊娠合并病毒性肝炎[J]．中国实用妇科与产科杂志，2004，20(2)：65．
[24]Lin HH, Kao JH, Hsu HY, et al.Least microtransfusion From Mother to Fetus in Elective Cesarean Delivery.Obstet Gynecol, 1996, 87:244-248.
[25]王清图，修霞，郭永，等．不同方案阻断乙肝病毒母婴传播的临床研究[J]．临床肝胆病杂志,2002,18(1)：51-52．
[26]Wang JS,Zhu QR,Zhang XZ. Effect of delivery mode on maternal-infant transmission of hepatitis B virus by immunoprophylaxis.Chinese Medical Journal,2002, 115(10):1510-1512.
[27]钱燕华．分娩方式对乙型肝炎母婴传播阻断效果的影响[J]．职业与健康,2006,22(17)：1332-1334．
[28]马力，赵桂珍，曲以琴，等．HBV携带产妇的婴儿乙肝基因疫苗免疫后母乳喂养安全性的研究[J]．中国公共卫生杂志，2000，16(3)：269-270．
[29]黄建宏，林心，林瑞贞，冯小三，等．HBV感染产妇乳汁中乙肝病毒标志物检测分析．国外医学临床生物化学与检验学册,2005,26(5)：271-272．
[30]杨晓，崔敏娴，刘保根．乙型肝炎血清学指标阳性母亲哺乳问题的研究．中华妇产科杂志，1994,29(10)：586．
[31]Wu M Ingm Ing, Tang Yinrong, Guo Ca Iyu, et al. The result observation of HBV carried lying-in women who has been taken the measure of interdiction [J]. China J Obstet Gynecol, 2002, 37:235-236.
[32]姚琦玮，李敦华，陈颖，等．联合免疫后HBV携带者母乳喂养的安全性研究．中国实用妇科与产科杂志,2004,20(2)：109～110．
[33]陈勇峰。乙型肝炎病毒与母乳喂养．中国实用妇科与产科杂志，1997，13(2)：676-677．
[34]朱启镕，吕晴，俞惠，等．宫内感染HBV婴儿接种乙肝疫苗免疫失败的机理和预后研究[J]．中华儿科杂志，1997,35：349-352．
[35]曾义岚，吴俭，王丽，胡蓉，卜惠敏，朱丽新．乙型肝炎病毒血清学复制指标阳性产妇哺乳安全性探讨[J]．四川医学,2003,24(8)：823-824．
[36]蒋丽霞，郑奎,王荣华，等．乙肝免疫球蛋白在预防HBV宫内感染中的作用[J]．中国现代医学杂志,2002,21(12)：85-86．
[37]刘海英，马玉燕，崔保霞，戴(曰文)笙，杨洁．孕妇乙肝免疫球蛋白被动免疫阻断HBV母婴垂直传播作用机理的研究[J]．现代妇产科进展,2002,11(2)：128-130．
[38]洪善玲，王波君，孙佰风，赵琰清，殷桂云，赵晶晶．早孕期应用HBIG阻断乙肝母婴垂直传播、乳汁传播的临床研究[J]．医药产业资讯，2006，15(3)：15-16．
[39]Xiao XM, Li AZ, Chen X, Zhu YK, Miao J.Prevention of vertical hepatitis B transmission by hepatitis B immunoglobulin in the third trimester of pregnancy. Int J Gynaecol Obstet. 2007 Mar;96(3):167-70.
[40]朱科伦，马佩球，张为民，等．HBV阳性孕妇接种乙肝免疫球蛋白后免疫学反应的研究[J]．广州医药，2004，35(1)：1-2．
[41]郭永，王建芹，李萌萌，等．孕期干预阻断乙肝病毒母婴垂直传播的结果分析[J]．中国优生与遗传杂志,2005,13(2)：78-79．
[42]Van Nunen AB,De Man RB,Heijtink RA,et al.Lamivudine in the last 4 weeks of pregnancy to prevent perinatal transmission in hightly viremie chronic hepatitis B patients[J].J Hepatol,2000,32(6):1040-1041.
[43]韩忠厚，陈妍华，苏雪松，等．拉米夫定联合主被动免疫阻断乙型肝炎病毒母婴垂直传播[J]．河北医药，2005,27(1)：23-24．
[44]Kazim SN,Wakil SM,Khan LA,et al.Vertical transmission of hepatitis B virusdespite maternal lamivudine therapy[J].Lancet,2002,359(9316):1488-1499.
[45]王家祥，郭晓华，张燕，等．解毒复肝灵抑制乙肝病毒母婴宫内传播的临床观察[J]．中国中西医结合杂志,2003,23(4)：310-311．
[46]纪向虹，戚红．不同分娩方式对HBV母婴传播的影响[J]．山东医药,2002,42(15)：18-19．
[47]李红，王中弥，黄燕，等．乙肝免疫球蛋白阻断母婴传播机制的研究[J]．中国优生与遗传杂志，2002,10(4)：68-69．
[48]徐德忠，闫永平，王素萍，刘蓬勃，白钢钻，王歆，史梦远，王雪萍，胎盘组织在乙型肝炎病毒宫内传播中的作用及其机制研究[J]，中华医学杂志,2001，3(81)：176-177．
[49]郦爱贞，肖小敏，陈新，吴莉莉，路妍妍，FcγRⅢ在乙型肝炎病毒胎盘感染中作用的研究[J]．中国优生与遗传杂志,2006,14(5)：59-60．
[50]曹宝花，门可，徐德忠，闫永平，张景霞，王文勇．探讨HBsAg/Annexin V检测在HBV宫内传播中的意义[J]．第四军医大学学报，2004；25(7)：581-583．
[51]Lin HH,Lee Y, Chen DS,Sung JL,Ohto H,Etoh T, Kawana T, Mizuno M.Transplacental leakage of HbeAg-positive maternal blood as the most likely route in causing intrauterine infection with hepatitis B virus.[J]Pediatr, 1987,111(6):877-881.
[52]Xu DZ, Yan YP, Choi BC, Xu JQ, Men K, Zhang JX, Liu ZH, Wang FS. Risk factors and mechanism of transplacental transmission of hepatitis B virus: a case-control study. J Med Virol, 2002,67(1):20-26.
[53]王素萍，徐德忠，闫永平，等．乙型肝炎病毒宫内传播危险因素的研究．中国公共卫生学报．1999，18(4)：251-252．
[54] Stoll-Becker, Repp R,Glebe D,et al .Transcription of hepatitis B virus in periphdral blood mononuclear cells from persistently infection patients[J].J Virol, 1997,71(7):5399-5407.
[55] 魏俊妮，王素萍，等．乙型肝炎病毒宫内感染的细胞分子机制[J]．代预防医学杂志，2005，32(2)：94-95．
[56] 门可，徐德忠，闫永平，等．血HBsAg，HbeAg阳性孕妇外周血单个核细胞HBV感染的研究．中华妇产科杂志．1996，31(10)：597-599．
[57] Hadchouel M, Scotto J, Huret JL, Molinie C, Villa E, Degos F, Brechot C. Presence of HBV-DNA in spermatozoa: a possible vertical transmission of HBV via the germ line. J Med Virol, 1985, 16(1):61-66.
[58] Taylor PJ, Gill MJ, Mahadevan M, Pattinson HA. Hepatitis B virus in human follicular fluid. Fertil Steril, 1987, 48(3):514.
[59] Huang J M,Huang T H,Qiu H Y, et al.Studies on the integration of heptitis B virus DNA sequence in human sperm chromo somes[J].Asian J Androl,2002,4(3):209-212.
[60] Zenclussen AC,Blois S,Stumpo R,Olmos S,Arias K,Malan Borel I,Roux ME,Margni RA.Murine abortion is associated with enhanced interleukin-6 levels at the feto-matemal interface.Cytokine,2003,21,24(4):150-60.
[61] Deb S,Tessier C,Prigent-Tessier A,Barkai U,Ferguson-Gottschall S,Srivastava RK,Faliszek J,Gibori G.The expression of interleukin-6 (IL-6), IL-6 receptor, and gp130-kilodalton glycoprotein in the rat decidua and a decidual cell line: regulation by 17beta-estradiol and prolactin. Endocrinology. 1999,140(10):4442-50.
[62] Dame JB,Juul SE,The distribution of receptors for the pro-inflammatory cytokines interleukin (IL)-6 and IL-8 in the developing human fetus.Early Hum Dev,2000,58(1):25-39.
[63] Steinborn A,Geisse M,Kaufmann M.Expression of cytokine receptors in the placenta in term and preterm labour.Placenta. 1998,19(2-3):165-70.
[64] Neurath AR,Strick N,Li yy.Cells transfeeted with human interleukin-6 cDNA acquire binding sites for the hepatitis B virus envelope protein.J ExpMed, 1992,176(6):1561-1569.
[65] Galun E, Nahor O, Eid A, Jurim O, Rose-John S, Blum HE, Nussbaum O,Ilan E, Daudi N,Shouval D,Reisner Y, Dagan S.Human interleukin-6 Facilitates hepatitis B virus infection in vitro and in vivo.Virology,2000,270(2):299-309.
[66]Heinz D,Peters M,Prange Gerken G, Rose-John S.Possible role of human interleukin-6 and soluble interleukin-6 receptor in hepatitis B virus infection.J Viral Hepat, 2001,8(3):186-193.
[67]李铁钢，王素萍．胎盘组织在HBV宫内感染中的作用．中国优秀博硕士论文．2004．
[68]王素萍，徐德忠．乙型肝炎病毒宫内感染的研究现状及今后工作重点[J]．中华流行病学杂志,2005,26(4)：229-231．
[69]Huang K,Lin S.Nation wide vaccination: A successstory in Taiwan[J].Vaccine,2000,18(Supp1):35-38.
[70]尚涛．乙型肝炎病毒的母婴传播及预防．中国实用妇科与产科杂志，2001，17(6)：330-332．
[71]王建设，朱启镕．阻断乙型肝炎病毒母婴传播的研究进展．中华肝脏病志,2002,10(4)：308-310．
[72]郦爱贞，肖小敏，乙肝病毒宫内感染临床诊断标准的探讨[J]．中国妇幼保健,2007,22(4)：475-477．
[73]Vranckx R, Alisjahbana A, Meheus A. Hepatitis B virus vaccination and antenatal transmission of HBV markers to neonates. J Viral Hepat,1999,6(2):135-139.
[74]陈灵，吴小红，李静．妊娠合并乙型肝炎宫内感染及对策．中国妇幼保健,2004,19(10)：74-75．
[75]骆抗先主编．乙型肝炎—基础和临床.北京：人民卫生出版社，1997,233．
[76]朱启镕，于广军，吕晴，俞蕙，顾新焕，张秀珍，董左权．阻断乙型肝炎病毒宫内传播的随机对照研究[J]．中华儿科杂志,2002,40(8)：478-480．
[77]王丽峰，杨岚，邱文山，杨冬，乙肝表面抗原阳性孕妇肌注乙肝免疫球蛋白预防母婴传播的效果[J]．广东医学,2006,27(6)：898-899．
[78]肖小敏，陈新，李耘，叶志海，何明娇，徐玉苑．HBsAg阳性孕妇产前应用乙型肝炎免疫球蛋白提高婴儿对乙型肝炎疫苗的免疫反应[J]．新医学,2005,10(36)：567-569．
[79]徐德忠，闫永平，徐剑秋，等．乙型肝炎病毒宫内传播机制的分子流行病学研究[J]．中华流行病学杂志，1998,19(3)：131-133．
[80]Beasley RP, Trepo C,Stevens CE,et al.Thee antigen and vertical transmission of hepatitis B surface antigen[J].Am J Epidemiol, 1977,105(2):94-98.
[81]Kadak,Kamiyama I,Inomata M,et al.Eantigen and antiein theserum of asymptomatic carder mothers as in dicator sofpositive and negative transmission of hepatitis B virus to tue irinfants[J].N Eng I J Med, 1976,294(14):746-749.
[82]Bertoletti A,Maini MK. Protection or damage:adual role for the virus specific cytotoxin Tlym phocyte response in hepatitis B and Cinfection?Curr Opin Microbiol,2000,3(4):387-392.
[83]崔恒春，闫永平，邵中军，徐德忠，门可，徐剑秋，李军，免疫预防后HBeAg与HBV宫内感染分析[J]．中国公共卫生,2006,22(7)：824-826．
[84]尚涛．乙型肝炎病毒的母婴传播及预防．中国实用妇科与产科杂志，2001，17(6)：330．
[85]马宁生，朱敏，应红华，林益平．孕妇产前进行免疫阻断与新生儿乙型肝炎基因疫苗免疫效果关系的研究[J]．中国实用儿科杂志,2006,21(1)：29-31．
[86]Lee SD,Lo KJ,Tsai YT, et al.Role of caesarena section in prevention of mother-infant transmission of hepatitis B vires.Lancet,1988,2(8615):833-834.
[87]Hill JB, Sheffield JS, Kim M J, Alexander JM, Sercely B, Wendel GD._Risk of hepatitis B transmission in breast-fed infants of chronic hepatitis B carriers.Obstet Gynecol. 2002,99(6):1049-1052.
[88]陈慧文，郭悦青，陈旭，温国明，徐明锐，叶关泉．产妇携带乙肝病毒对哺乳影响的研究[J]．数理医药学杂志,2004,17(5)：411-413．
[89]孟钊，肖小敏，何明娇，徐玉苑，李耘．乙肝病毒携带产妇HBIG应用及不同喂养方式对婴儿的影响[J]．实用医学杂志,2004,20(10)：1102-1104．
[90]姚琦玮，李敦华，陈颖，黄夏娣．联合免疫后HBV携带者母乳喂养的安全性研究[J]．中国实用妇科与产科杂志,2004,20(2)：109-110．
[91]牟瑞丽，马玉燕，李桦，孔北华，江森．乙型肝炎病毒携带者母乳喂养的研究[J]．中华围产医学杂志,2005,8(1)：20-23．
[92]王元，何成章，黄文琴，蔡祥莺，姚建敏．联合免疫后乙肝病毒母婴传播相关因素的临床研究[J]．中国妇幼保健,2005,20(13)：1655-1657．
[93]张惠忠，马明孝，李霞，田美晴．304例阻断HBV母婴传播效果观察[J]．中西医结合肝病杂志,2005,15(5)：289-290．
[94]冯松婉，江玲娟．乙肝表面抗原阳性产妇婴儿喂养方式探讨[J]．中国农村卫生事业管理,2005,25(4)：63．
[95]安玉香，白洁，韩美俊，杨桂生，马广慈，申伟．174例HBsAg阳性产妇婴儿母乳喂养与人工喂养HBV感染情况对比[J]．中国初级卫生保健，1995,9(9)：38．
[96]王小青，刘亦琪，孙亦骏，蒋涛，吴斌．母乳喂养传播乙型肝炎病毒的临床研究[J]．江苏医药，1996,22(12)：827-828．
[97]马力，赵桂珍，曲以琴，梁争伦，吴小音，钟熙．HBV携带产妇的婴儿乙肝基因疫苗免疫后母乳喂养安全性的研究[J]．中国公共卫生,2000,16(3)：269-270．
[98]曾文铤，朱科伦，马佩球，邓志校，卫建筠，叶新民．母乳喂养与乙型肝炎病毒传播的临床研究[J]．中西医结合肝病杂志,2001，11(1)：13-14．
[99]陈涛，相龙云，彭华彬，赵金凤．产妇乙肝病毒感染者血清及乳汁中HBV-DNA定量检测分析[J]．现代医药卫生,2006,22(12)：1880-81．
[100]孟钊，肖小敏，何明娇，徐玉苑，李耘．乙肝病毒携带产妇HBIG应用及不同喂养方式对婴儿的影响[J]．实用医学杂志,2004,20(10)：1102-1104．
[101]Hill JB, Sheffield JS, Kim MJ, Alexander JM, Sercely B, Wendel GD._Risk of hepatitis B transmission in breast-fed infants of chronic hepatitis B carriers.Obstet Gynecol.2002;99(6):1049-52.
[102]王建设，朱启镕，张公惠，费林娥．母乳喂养不影响乙型肝炎病毒母婴传播阻断效果[J]．中华围产医学杂志,2003,6(1)：24-27．
[103]陈宏．死胎胎盘组织中HBV-DNA测定及意义[J]．山东医药,2002,42(3)：53．
[104]晏路标，肖昕，熊爱华．胎盘Hofbauer细胞在乙型肝炎病毒母婴垂直传播中的作用[J]．实用儿科临床杂志,2006,21(6)：351-358．