新生儿乙肝指标预测宫内感染价值评价

The value of neonates hepatitis B virus indexes in diagnosing HBV intrauterine infection

目的探讨新生儿出生时乙肝指标用于预测和诊断乙型肝炎病毒(HBV)宫内感染的价值。方法选取2006年6月至2010年3月中山大学附属第三医院HBsAg阳性孕妇分娩新生儿1360例,于出生24 h内行主被动联合免疫,并随访至12个月龄,检测0、7、12个月龄外周血HBV标志物及HBV DNA。将新生儿出生时HBsAg阳性、HBV DNA阳性、HBsAg和HBV DNA双阳性、HBsAg和(或)HBV DNA阳性等4项指标纳入ROC曲线,分析其对宫内感染的预测和诊断价值。结果 (1)出生时HBsAg和(或)HBV DNA阳性145例,随访至7和12个月龄仅剩21例阳性,均为从出生至7和12个月龄HBsAg持续阳性者,宫内感染率为1.54%。(2)4项指标中,新生儿出生时HBsAg阳性预测宫内感染的灵敏度和阴性预测值最高(100%);HBsAg和HBV DNA双阳性特异度和阳性似然比最高(99.6%和214.25)。结论新生儿经联合免疫,可分别将出生时HBsAg阳性、HBsAg和HBV DNA双阳性以及出生至7个月龄HBsAg持续阳性作为宫内感染的筛查、预测和诊断指标。

Objective To investigate the value of neonates hepatitis B virus （HBV） indexes in prediction and diagnosis of HBV intrauterine infection. Methods 1360 neonates which born in HBsAg positive pregnant women were collected as subjects. All neonates received active and passive immunization within 24h after birth. Infantile blood samples were col- lected and tested for HBV markers and HBV DNA at 0,7 and 12 months of age. Neonatal HBsAg-positive, HBV DNA- positive, HBsAg and HBV DNA double positive, HBsAg and/or HBV DNA positive at birth were evaluate the value of prediction and diagnosis of HB~ intrauterine infection using ROC curves. Results （ 1 ） There were 145 neonates were HBsAg and/or HBN DNA positive at birth. Followed up to 7 and 12 months of age, only 21 infants were HBsAg and/or HBN DNA positive, all of them were HBsAg positivity from birth to 7 and 12 months of age. The rate of intrauterine in- fection was 1.54%. （2） Neonatal HBsAg-positive has the highest sensitivity and negative predictive value （100% and 100% respectively）, while neonatal HBsAg and HBV DNA double positive has the highest specificity and positive likeli- hood ratio （99.6% and 214.25 respectively） to diagnose HBV intrauterine infection. Conclusion After received active and passive immunization, neonatal HBsAg-positive, HBsAg and HBV DNA double positive at birth, and HBsAg positiv- ity from birth to 7 months can be used as a screening, predicted and diagnostic index of HBV intrauterine infection re- spectively.