乙肝病毒宫内感染临床诊断标准的探讨

Study of the clinical diagnostic criteria of intrauterine Hepatitis B Virus infection

目的探讨乙型肝炎病毒宫内感染的临床诊断标准。方法选取439例HBsAg阳性孕妇及其所生的442例新生儿作为研究对象,新生儿于出生后24h内、1月龄、6月龄检测外周血HBV-M。结果新生儿出生24h内HBsAg、HBV-DNA阳性率分别为12.7%、2.3%,1月龄为6.8%、2.5%,6月龄为5.6%、2.5%,24h内HBsAg和(或)HBeAg和(或)HBV-DNA阳性的新生儿为85例,阳性率为19.2%,单项HBeAg阳性者于1月龄全部阴转;新生儿1月龄复查HBsAg时有34例阴转,阴转率为60.7%,出生至1月龄HBsAg持续阳性率为5.0%,出生至6月龄HBsAg持续阳性率为4.3%,1月龄HBsAg阳转并持续至6月龄者有5例。结论HBV-DNA特异性高,但不全面,HBeAg易通过胎盘造成新生儿HBeAg血症,经联合免疫很快清除,因此把HBsAg作为检测指标较合适;婴儿1月龄血HBsAg阳性可作为HBV宫内感染的筛查指标,而6月龄血HBsAg阳性则可作为HBV宫内感染的确诊指标。

Objective： To investigate the clinical diagnostic criteria of intrauterine hepatitis B virus infection. Methods： 439 HBsAg positive pregnant women and their 442 newborns were selected. All newborns were detected the venous blood hepatitis B virus markers （HBV - M） within 24 hours after birth, followed at 1, 6 months of age. Results： The positive rates of HBsAg and HBV - DNA were 12. 7% and 2. 3% within 24 hours after birth, 6. 8% and 2. 5% at 1 months of age, 5.6% and 2.5% at 6 months of age, the blood HBsAg and/or HBeAg and/or HBV - DNA positive newborns had 85 cases within 24 hours after birth, the rate was 19. 2%, the ones only HBeAg positive were all become to negtive at 1 months of age ; 34 HBsAg positive newborns was become to negtive at 1 months of age, the rate was 60. 7%, the rate of HBsAg keep on positive from birth to 6 months of age was 5.0%, and 4. 3% from 1 to 6 months of age, 5 newborns＂ HBsAg came to positive at 1 months of age and continued to 6 months of age. Conclusion： HBV - DNA has high specificity, but not overall. HBeAg can pass the placenta easily and make the newborn - HBeAg -emia, and can be eliminated by combined immunization, so it is suitable comparatively to use HBsAg as the detection index; The HBsAg positive at 1 month of age can be used as the screening index of HBV intrauterine infection, and the HBsAg positive at 6 months of age can be used as the final diagnostic index.