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目的 了解HBeAg阳性孕妇妊娠早期HBV复制受到抑制后的HBeAg滴度与自然杀伤(NK)细胞水平变化.方法 回顾性分析泰州市人民医院2010年9月至2013年4月收治的54例HBeAg阳性孕妇的临床资料,其中妊娠12周时HBV DNA下降2 log以上者24例为免疫激活组,HBV DNA无下降者30例为免疫耐受组,比较两组患者的ALT、总胆红素、HBsAg和HBeAg滴度、HBV DNA定量及NK细胞百分比及绝对值水平.结果 妊娠12周时免疫激活组ALT水平(146.7±93.1)U/L,并有12例(50％)血ALT水平升高,与免疫耐受组ALT水平[(44.1±14.7)U/L]、ALT异常例数(2例)及比例(7％)相比明显升高(t=2.95,x2=4.97,均P＜0.05).两组HBeAg滴度妊娠前分别为(467.4±226.6)与(451.5±274.0) S/CO,差异无统计学意义,妊娠12周时免疫激活组HBeAg滴度下降至(291.8±170.5)S/CO,免疫耐受组为(443.7±289.9)S/CO,两者比较差异有统计学意义(t =2.81,P＜0.05).而NK细胞绝对数及百分比免疫激活组和免疫耐受组依次为(370.9±136.4)/μl、(26.7±9.1)％及(213.2 ±97.8)/μl、(17.1±7.8)％,NK细胞在免疫激活组中活化明显(t值分别为2.38和2.52,均P＜0.05).结论 妊娠早期部分乙肝携带者孕妇可能通过NK细胞途径达到抑制病毒复制作用.

Objective To investigate serum NK cell levels in HBeAg positive early pregnancy women with immune activation.Methods Fifty four HBeAg positive pregnant women admitted in Taizhou People's Hospital from September 2010 to April 2013 were enrolled in the study.Among them,the serum HBV DNA load decreased ≥2 log at 12 weeks after pregnancy in 24 cases (immune activation group) and HBV DNA did not decrease in 30 cases (immune tolerance group).The serum level of alanine aminotransferase (ALT),total bilirubin,HBeAg,HBV DNA load and NK cells were measured.Results At week 12 of gestation,the mean ALT levels and ALT abnormality rate in immune active group were higher than those in immune tolerance group [(146.7 ±93.1) vs.(44.1 ± 14.7) U/L,t =2.95,P＜0.05,50.0％ vs.6.7％,x2 =4.97,P ＜0.05].There was no significant difference of HBeAg level between two groups before pregnancy,while HBeAg level in immune activation group was lower than that in immune tolerance group at week 12 week of gestation [(291.8 ± 170.5) vs.(443.7 ± 289.9) S/CO,t =2.81,P ＜0.05].The percentage and absolute number of NK cells in immune activation group were higher than those in immune tolerance group [(26.7 ±9.1)％ vs.(17.1 ±7.8)％,t =2.52,P ＜0.05 and (370.9 ±136.4)/μl vs.(213.2 ±97.8)/μl,t =2.38,P ＜0.05,respectively].Conclusions In HBeAg positive early pregnant women with immune activation,the inhibition of HBV DNA might be associated with the activation of NK cells.