乙型肝炎病毒感染孕妇孕晚期HBIG宫内阻断失败相关因素分析

Analysis of correlation factors of intrauterine interruption failure for HBV infected pregnant women using HBIG during in the last trimester of pregnancy

目的对晚孕期注射HBIG行宫内阻断的HBV-DNA阳性孕妇的新生儿的宫内阻断失败发生情况进行研究,分析母婴宫内阻断失败的相关因素。方法将250例HBV-DNA阳性孕妇及其子女随访至1月龄,根据母血HBV-DNA定量(copies/ml)分为4组:1组<106级、2组106级、3组107级、4组≥108级,研究HBV-DNA含量与宫内阻断失败的关系。选择高病毒载量孕妇(HBV-DNA≥106copies/ml)及其所生子女各114例分为宫内阻断成功组和失败组两组进行其他原因分析。结果随母血HBV-DNA含量增高,宫内阻断失败率随之增加,四组失败率分别为0.74%、8.33%、15.38%、41.67%,P<0.05;HBeAg定量分析成功组与失败组比较t=3.223,P<0.05;两组孕妇年龄、孕次产次、分娩时胎龄、分娩方式、先兆流产、先兆早产发生情况、新生儿性别等差别无统计学意义(P>0.05);HbcAb定量两组下降幅度比较t=5.437,P<0.05,有统计学意义。结论血清HBV宫内阻断失败的相关因素主要为母体HBV-DNA浓度,宫内感染可能与胎儿血清HBcAb量有关。

Objective： To study the failure rate of interruption interuterine HBV infection of the pregnant women whose HBV - DNA is positive and used HBIG to interrupt interuterine infection during the last trimester , and analyze the correlation factors of intrauterine interruption failure. Methods ： 250 pregnant women with HBsAg and HBV - DNA positive who were given HBIG 200IU every 2 weeks during the laster trimester. Divide them into 4 groups as group 1, 2, 3, 4 whose blood titer of HBV is 〈 10^6grade, 10^6grade, 10^6grade, ≥ 10^8grade respectively to analyze the relaitionship between intrauterine interruption failure rate and serum virus content. 114 women with high blood titer of HBV were divided into 2 groups according to whether their infants were intrauterine infected to analyze other factors . Results ： 20 of 248 newborns were intrauterine infected by HBV. The failure rate of the four groups is 0. 74%, 8. 33%, 15.38%, 41.67% , respectively . The value of association between the HBV infection rate and virus content in gravida＇serum showed statistical significance. HBeAg content showed statistical significance between the successful group and the interuterine HBV infection group. But age, gravidity and parity, gestational age, way of delivery , threatened abortion or premature dilivery , gender of infants didnt showe statistical significanc. The content of HBcAb in high titer of virus descented more quickly than the low titer of virus group and have statistical significance. Conclusions ： The main factor of interuterine interruption failure is high HBV DNA content of pregnant women . It may be concerned with HbcAb content in the infants＇serum.