乙型肝炎病毒宫内感染的机率及感染因素的调查研究

PROBABILITY OF HEPATITIS B VIRUS ENDOUTERINE INFECTION AND RELATED FACTORS

目的了解乙型肝炎病毒（ＨＢＶ）携带者妊娠后胎儿宫内感染的机率及造成宫内感染的相关因素。方法筛选产前检查中乙型肝炎病毒血清标志物（ＨＢＶＭ）阳性孕妇作为观察对象，用孕妇外周血与其婴儿的脐带血配对送检，检查ＡＬＴ、ＴＢＩＬ、Ａ／Ｇ、ＨＢＶＭ及ＨＢＶＤＮＡ；同时调查与宫内感染的有关因素。结果１１２例ＨＢＶＭ阳性产妇与其配对婴儿脐带血ＨＢＶＭ阳性４８例，占４２．９％（４８／１１２）；宫内感染与孕妇的肝功能异常，ＨＢｅＡｇ、ＨＢＶＤＮＡ阳性与否，产程的长短及婴儿父亲的ＨＢＶ携带情况有关；而与分娩方式、胎盘大小、脐带长短、产妇的年龄、婴儿的性别及体质量等无关。结论ＨＢＶ宫内感染的机率较高，是造成婴儿免疫失败的主要原因。因此，应加强孕期保健，避免孕妇的肝功能损害，提倡孕前检查，如夫妇或单方ＨＢｅＡｇ和ＨＢＶＤＮＡ阳性应转阴后再妊娠。一旦妊娠，分娩时应尽量缩短产程，减少ＨＢＶ携带的机率。

ObjectiveTo understand the probability of fetus infection by HBV carrying mothers and the related factors of uterine infection.MethodsPositive HBVM pregnant women were screened as objectives in the usual examinations before delivery.The peripheral blood of pregnant women and umbilical blood of babies were matched in the test of ALT,TBIL,A/G,HBVM and HBVDNA.Meanwhile related factors of uterine infection were investigated.ResultsForty eight babies out of 112 cases were HBVM positive in the test of umbilical cord blood,accounting for 42.9 %.Endouterine infection had correlation with hepatic function of the mother,positiveness of HBeAg and HBVDNA,duration of delivery and HBV infection of the father.But it had little to do with the fashion of delivery, size of placenta,length of umbilical cord,age of the mother,sex of the baby or weight of the baby.ConclusionProbability of HBV endouterine infection is high and is a main reason for immunity failure of the baby.So health care during pregnancy should be enhanced,avoiding hepatic function injure,and prepregnancy test advocated.If the couple or one of parents are positive,it is best not to bear. Once pregnant,delivery process should be shortened to decrease the probability of HBV infection.