慢性乙型肝炎病毒携带产妇母乳喂养安全性研究

Safety of Breast-Feeding Carried out by Chronic HBV Carriers

目的探讨乙型肝炎(乙肝)病毒携带产妇母乳喂养的安全性。方法对145例静脉血乙肝病毒血清标志物阳性的孕产妇进行脐血及母乳乙肝病毒血清标志物检测,同时对52例单纯乙肝病毒表面抗原(HBsAg)阳性产妇母乳喂养组及人工喂养组的新生儿出生时、出生7个月及12个月时进行静脉血乙肝病毒DNA(HBV-DNA)检测。结果 145例静脉血乙肝病毒标志物阳性产妇中136例新生儿脐血乙肝病毒标志物阳性,乙肝宫内感染率为94%;有32例母乳中乙肝病毒标志物阳性〔其中母血HBsAg阳性者12例,阳性检出率为23%;母血乙肝病毒e抗原(HBeAg)阳性者或HBsAg和HBeAg同时阳性者20例,阳性检出率为83%〕,阳性检出率为22%。单纯HBsAg阳性产妇母乳喂养组及人工喂养组的新生儿出生时、出生7个月及12个月时静脉血HBV-DNA检测阳性率比较,差异无统计学意义(P>0.05)。结论 HBsAg阳性的母亲所生婴儿可以给予母乳喂养,生后婴儿必须接受联合免疫;HBeAg阳性的母亲,因传染性强,不适合母乳喂养。

Objective To explore the safety of breast-feeding carried out by chronic HBV carriers.Methods HBV infectious markers were detected in umbilical cord blood and colostrum of 145 chronic HBV carrier mothers.Meanwhile,HBV DNA in 52 newborns with HBsAg（＋） mothers,either breast-fed or formula-fed,was detected at 0,7,and 12 months after born.Results HBV infectious markers were found to be positive in the umbilical cord blood in 136 out of the 145 HBV infectious marker-positive cases.The intrauterine HBV-infectious rate was 94%.HBV infectious markers were found to be positive in the colostrum in 32 out of the 145 cases with HBV infectious markers（HBV-infectious rate：22%）,12 with HBsAg（＋） mothers（positive rate：23%） and 20 with HBeAg（＋） mothers（positive rate：83%）.No statistical differences between the breast-fed group and the formula-fed group of newborns with HBsAg＋ mothers were noted with respect to HBV-DNA positive rate of newborns at 0,7,and 12 months after born.Conclusion Breast feeding could be carried out by HBsAg（＋） chronic HBV carriers and combined immunization should be performed in the infants at the same time.The colostrum of HBeAg（＋） mothers is highly infectious and is not suitable for breast-feeding.