应用巢式病例对照探讨HBV围生期传播的影响因素

Nested case-control study on the influence factors of perinatal stage transmission of hepatitis B virus

目的:探讨HBV围生期传播的影响因素,为防制HBV围生期传播提供科学依据。方法:应用1∶1匹配巢式病例对照研究,选择141对HBsAg阳性孕妇及所生的新生儿作为研究对象,进行问卷调查,并检测血液相关指标,资料采用单因素及多因素条件logistic回归分析对HBV围生期传播的影响因素进行分析。结果:单因素配对四格表χ2检验有统计学意义的因素为文化程度、一级家族史、肝功能异常、血清谷丙转氨酶、系统治疗、妊娠肝内胆汁淤积症(ICP)、胎儿宫内窘迫及接种乙肝免疫球蛋白等。进入条件logistic回归方程的影响因素为一级家族史、接种乙肝免疫球蛋白、系统治疗及妊娠肝内胆汁淤积症。结论:对肝功能异常的HBsAg阳性妇女孕前进行积极正规治疗,规范接种乙肝免疫球蛋白,防治妊娠肝内胆汁淤积症,可以降低HBV的围生期传播。

Objective To determine the influence factors of perinatal stage transmission of hepatitis B virus （HBV） and to provide scientific evidence for the prevention of perinatal stag transmission of HBV. Methods A 1：1 matched nested case-control study was conducted, and 141 pair of pregnant women with HBsAg-positive and their newborns were enrolled. A questionnaire was performed and bloodrelated indicators were detected. The data were dealt with single factor analysis and conditional logistic regression analysis using SPSS 13.0 and SAS 8. L Results Single factor paired Chi-square test showed that education, first class family history, disfunction of liver, serum glutamic-pyruvic transaminase, systematic treatment, intrahepatic cholestasis of pregnancy （ ICP）, fetal distress, and vaccinating hepatitis B immune globulin （HBIG） were the risk factors of perinatal stage transmission of HBV. Conditional logistic regression analysis indicated that first class family history, vaccinating HBIG, systematic treatment, and ICP were the risk factors of perinatal stage transmission of HBV. Conclusion For women with HBsAg-positive, active treatment, the standard vaccination of HBIG, and preventing and controlling the incidence of ICP may reduce the incidence of perinatal stage transmission of HBV.