乙型肝炎孕妇母婴传播影响因素分析

The analysis of influencing factors of maternal-infant transmission of hepatitis B virus

目的对乙型肝炎表面抗原(HBsAg)阳性孕妇母婴传播影响因素进行分析,探讨母婴传播的原因及对策。方法检测207例HBsAg阳性孕妇HBV血清标志物、血清HBV DNA,产妇乳汁HBV DNA,新生儿脐带血HBVDNA,并且对孕期一般情况、家族肝病史、是否进行孕晚期高效价乙型肝炎免疫球蛋白母婴阻断治疗、分娩方式、阿氏评分等进行多因素分析。结果 HBsAg(+)、HBeAg(+)、抗-HBc(+)的产妇,其乳汁HBV DNA阳性率为9.6%,HBsAg(+)、抗-HBe、抗-HBc(+)的产妇,其乳汁HBV DNA阳性率为2.43%,与HBsAg(+)、HBeAg(+)、抗-HBc(+)产妇乳汁HBV DNA阳性率比较差异有统计学意义(P<0.01);血清HBV DNA<105拷贝/mL的产妇其乳汁及新生儿脐血中检测HBV DNA均为阴性。血清HBV DNA>106拷贝/mL的产妇,其乳汁HBV DNA阳性率为12.5%,其新生儿脐血阳性率为15.17%;在多种因素中,孕晚期是否进行HBV母婴阻断是影响母婴传播的因素。结论 HBsAg(+)、HBeAg(+)、抗-HBc(+)的产妇,其乳汁HBV DNA阳性率高;产前血清高病毒载量的孕妇,其乳汁及新生儿脐血HBV DNA阳性率高;孕晚期注射高效价乙型肝炎免疫球蛋白对母婴阻断治疗有重要意义。

Objective To analyze the influencing factors of maternal-infant transmission of hepatitis B virus（HBV） in pregnant women with positive reaction of hepatitis surface antigen（HBsAg） and explore the reasons and countermeasures of maternal-infant transmission.Methods The statistic inquiry was done in 207 pregnant women,which included HBV serum immunology index,serum HBV DNA level,lying-in mother milk HBV DNA,newborn blood of umbilical cord HBV DNA.Also personal information,family history,the information on interception maternal-infant transmission of HBV by advanced stage high potency HBV immune globulin,the mode of delivery were included.Results The positive rate of milk HBV DNA in the puerpera with HBsAg（＋）、HBeAg（＋）、anti-HBc（＋）was 9.6% and that in the puerpera with HBsAg（＋）、anti-HBe（＋）、HBcAb（＋） was 2.43%.There was significant difference in breast milk between the puerpera with HBsAg（＋）、HBeAg（＋）、anti-HBc（＋） and the puerpera with HBsAg（＋）、anti-HBe（-）、anti-HBc（＋）（P0.01）.For the puerpera with serum HBV DNA105 copies/mL,the reaction of HBV DNA was negative in both breast milk and the newborn baby′s cord blood.For the puerpera with serum HBV DNA105 copies/mL,the positives rate of breast milk HBV DNA was 12.5% and that of the newborn baby′s cord blood HBV DNA was 15.17%.The treatment of maternal-infant interruption was the only influencing factor of maternal-infant transmission.Conclusion The virus load was high in the breast milk of lying-in women with positive reaction of HBsAg,the newborn baby′s cord blood and pregnancy serum.It could be effective to prevent the maternal-infant transmission by injecting HBV immunoglobulin to pregnant woman with HBV infection.