分娩方式对丙型病毒性肝炎母婴垂直传播的影响

Influence of delivery mode on maternal-infant transmission of hepatitis C virus

目的探讨丙型肝炎孕妇分娩方式对其新生儿丙型肝炎病毒(HCV)感染的影响,以降低新生儿HCV感染。方法 2010年1月-2011年12月行常规产前检查孕妇10 843例,筛查血清抗-HCV;凡抗-HCV阳性者列入研究对象,进行血清HCV-RNA检测,随访跟踪至产后,并对其新生儿抽取血样行HCV-RNA检测。结果孕妇丙型肝炎感染率为1.42%,HCV-RNA阳性者66.88%,HCV母婴传播率为17.48%;HCV-RNA阴性者33.12%,无1例新生儿感染;抗-HCV阳性孕妇分娩方式与HCV母婴传播无关;HCV-RNA阳性孕妇剖宫产组HCV母婴传播率低于阴道分娩组(P<0.05);HCV高病毒载量(HVL,HCV-RNA≥2.5×109拷贝/L)孕妇HCV母婴传播率高于非HVL组孕妇(P<0.05),HVL孕妇分娩方式与新生儿HCV感染有关(P<0.05),非HVL丙型肝炎孕妇的分娩方式与新生儿HCV感染无关。结论仅抗-HCV阳性的孕妇,分娩方式不影响HCV母婴传播率,HCV-RNA阳性的孕妇,特别是HVL的丙型肝炎孕妇,剖宫产能降低HCV母婴传播,可适当放宽剖宫产手术指征。

OBJECTIVE To evaluate the impact of delivery mode of the pregnant women on maternal-infant transmission of hepatitis C virus （HCV） so as to reduce the incidence of HCV infection in neonates. METHODS Anti-HCV antibody examination was performed for 10 843 pregnancy women who underwent the routine prenatal examination from Jan 2010 to Dec 2011. The pregnancy women with anti-HCV antibody tested positive were enrolled in this study and were performed for the detection of serum HCV-RNA. The follow-up lasted until the delivery, the blood of the neonate were sampled for the detection of HCV-RNA. RESULTS The incidence of HCV infection in the pregnancy women was 1.42%. The HCV-RNA positive rate of the HCV mothers was 66.88%. The maternal- infant transmission rate was 17.48% in the HCV pregnancy women positive for HCV-RNA and was 33.12% in the HCV pregnancy women negative for HCV-RNA, and none of their new-borns were positive with HCV-RNA. There was no correlation between the delivery mode of the mothers positive for anti-HCV antibody and the maternal-infant transmission of HCV. Of the pregnant women positive for HCV-RNA , the maternal-infant transmission rate of the caesarean section cases was lower than the vaginal delivery cases （P〈 0. 05）. The maternal-infant transmission rate of the mothers with high virus load （ HVL, HCV-RNA≥2. 5 × 10^9 copy/ml） was higher than the non-HVL cases（P〈0.05）. Of the cases with HLV, the deliver mode was related to the HCV infection in the neonates（P〈0.05）, and for the non-HLV cases, the delivery mode of the cases with hepatitis C was not related to the HCV infections in the neonates. CONCLUSION The delivery mode of the pregnant women positive for the anti-HCV does not influence the rate of maternal-infant transmission of HCV. For the pregnant women positive for HCV-RNA, especially the non-HVL cases with hepatitis C, to appropriately widen the surgical indications for the caesarean section can reduce the incidence of maternal-infant transmission of HCV.