乙型肝炎病毒母婴垂直传播相关临床因素分析

Clinical analysis of HBV vertical transmission

目的:探讨影响HBV母婴垂直传播的相关临床因素。方法:对2006年6月-2008年10月在中山大学附属第三医院产科产检和分娩的711例孕妇进行回顾性分析,分别比较HBeAg阳性孕妇和阴性孕妇的HBV DNA水平、产科情况、新生儿情况。结果:两组年龄、孕周、孕次、产次、先兆流产发生率、先兆早产发生率、胎膜早破发生率、分娩方式、配偶HBsAg阳性比例、新生儿体质量和性别比较差异均无统计学意义(P>0.05);阳性组孕妇HBV DNA水平≥109 copies/L者比例、妊娠期肝功能异常发生率、妊娠期注射乙型病毒性肝炎免疫球蛋白比例、新生儿HBsAg阳性和(或)HBV DNA阳性比例、满6个月龄婴儿HBsAg阳性比例均明显高于阴性组(P<0.05或0.01);HBV母婴垂直传播发生率为0.84%,其母亲入院时HBV DNA水平均超过≥1010 copies/L,HBeAg均为阳性。HBsAg阳性孕妇HBV DNA载量≥1011copies/L时,发生HBV母婴垂直传播的相对危险度为20.00。结论:HBeAg阴性孕妇未见HBV母婴垂直传播,HBV DNA水平越高,HBV母婴垂直传播的危险度越高。

Objective： To discover the clinical factors influencing HBV vertical transmission through analyzing the clinical data of gravida with HBV infection. Methods： Seven hundred and eleven pregnant women with HBV infection, who gave birth in obstetric department of the third affiliated hospital of SUN Yat-sen University were in- volved. Their clinical data such as HBV DNA level, obstetric situation, lactation situation and whether their babies acquired HBV infection were retrospectively analyzed and compared between HBeAg-positive gravida and HBeAg- negative gravida. Results： No statistical differences were found in age, gestational week, gravidity, parity, threat- ened abortion, threatened premature delivery, premature rupture of membrane, modes of delivery, spouse HBsAg positive rate, newborn weight and gender between the two groups. However, significant differences existed in HBV DNA level, abnormal liver function during pregnancy, intramuscular administration of HBIG during pregnancy, newborn HBsAg positive and （or） HBV DNA positive rate and the number of babies acquiring HBV infection be- tween the two groups. The rate of HBV vertical transmission was 0. 84%. When maternal HBV DNA level was no less than 10II copies/L, the relative risk of vertical transmission was 20. Conclusion： HBeAg-negative gravida had no vertical transmission. The higher HBV DNA level is, the grater the risk of vertical transmission is.