乙型肝炎病毒母婴传播风险因素评估

Evaluation of risk factors related to mother-to-child transmission of hepatitis B virus

目的研究乙型肝炎病毒(hepatitis B virus,HBV)母婴传播的风险因素,并对其进行相关评估。方法回顾性研究2007-2011年163例乙肝表面抗原(HBsAg)阳性孕妇分娩时的孕周、分娩方式、静脉血HBV DNA水平、喂养方式与HBV母婴传播的关系。结果在常规预防接种后HBV母婴传播率为4.29%(7/163)。孕妇HBV DNA含量越高时,新生儿脐血HBV DNA及随访的婴儿静脉血HBV DNA阳性率越高,差异均有统计学意义(P<0.01)。新生儿脐血HBVDNA水平与出生后6个月静脉血HBV DNA水平有关(P<0.05)。孕妇分娩时的孕周、分娩方式、喂养方式与HBV母婴传播均无关(P>0.05)。结论分娩方式、喂养方式是HBV母婴传播的低风险因素,围生期孕妇静脉血HBV DNA水平是HBV母婴传播的高风险因素。剖宫产不能降低HBV母婴传播风险。母乳喂养与混合喂养并不会增加HBV母婴传播风险。

Objective To study and evaluate the risk factors of mother-to-child transmission of hepatitis B virus（HBV）.Methods The relationships of gestational weeks,delivery modes,peripheral blood HBV DNA levels and feeding ways with mother-to-child transmission of HBV were retrospectively analyzed in 163 HBsAg-positive pregnant women from 2007 to 2011.Results The rate of mother-to-child transmission of HBV was 4.29%（7/163） after routine preventive inoculation.The peripheral blood HBV DNA level in the pregnant women was positively correlated with the cord blood HBV DNA level in newborn infants and the venous blood HBV DNA level in during infants follow-up（P〈0.05）.The cord blood HBV DNA level in newborn infants was significantly related to the venous blood HBV DNA level in 6-month-old infants（P〈0.05）.Gestational weeks,delivery modes and feeding ways were not related to mother-to-child transmission of HBV（P〈0.05）.Conclusion Delivery modes and feeding ways are low risk factors,and the maternal peripheral blood HBV DNA level is a high risk factor for mother-to-child HBV transmission,which can not be reduced by cesarean section or increased by breast feeding and mixed feeding.