分娩方式对乙型肝炎病毒母婴垂直传播的影响

Effect of Delivery Mode on Hepatitis B Virus Mother-to-child Vertical Transmission

目的 探讨不同分娩方式对乙型肝炎病毒（儿BV）母婴垂直传播的影响,为控制儿BV母婴垂直传播提供参考.方法 选取2012年1～6月松滋市计划生育服务站收治的HBsAg阳性孕妇150例及其分娩的活产新生儿152例为研究对象,按照分娩方式不同分为阴道分娩组（64例）及剖宫产分娩组（86例）,检测孕妇血清儿BV标志物及儿BV DNA水平,新生儿出生后肌内注射乙型肝炎免疫球蛋白、重组酵母乙型肝炎疫苗,比较两组婴儿主被动免疫阻断效果.结果 两组婴儿出生24h之内、3个月、6个月的儿BsAg及儿BsAb阳性率比较差异均无统计学意义（P＞0.05）,产妇儿BV DNA≤1011 copies/mL时分娩的新生儿儿BV阻断失败率两组比较差异无统计学意义（P＞0.05）,儿BVDNA＞ 1011 copies/mL阻断失败率比较差异具有统计学意义（x2 =4.87,P ＜0.05）.结论 儿BsAg阳性孕妇HBV DNA≤1011 copies/mL时,分娩方式对HBV垂直传播影响不大,但HBV DNA＞ 1011 copies/mL时建议选择剖宫产.

Objective To investigate the effect of delivery modes on hepatitis B virus （HBV） vertical transmlsslon,in order to provide reference for control of HBV vertical transmission from mother to child. Methods Total of 150 pregnant women with positive HBsAg and their alive newborns （ 152 babies） from Jan. to Jun. of 2012 from Songzi Family Planning Service Station Hospital were collected, according to the mode of delivery, the women were divided into vaginal delivery group（64 cases） and Cesarean section group （86 cases）. The serum HBV markers and HBV DNA levels were detected;intramuscular injection hepatitis B immune globulin, recombinant yeast hepatitis B vaccine were given to the newborns, and the active and paasive immunity effect were repaired. Results The positive rates of HBsAg and HBsAb of the two groups within 24 h of birth, 3 months,6 months after birth showed no statistically significant difference （ P 〉 0.05 ）. For cases with maternal HBV DNA ≤ 10^11 copies/mL, HBV blocking failure rate of the two groups had no statistically significant difference （P 〉 0.05 ）, for cases with maternal HBV DNA 〉 10^11 copies/mL, blocking failure rate of the two groups had statistically significant difference （ x^2 = 4.87, P 〈 0.05 ）. Conclusion For HBsAg positive pregnant women with HBV DNA ≤ 10^11 copies/mL, delivery mode has little effect on HBV vertical transmission, for those with H BV DNA 〉 10^11 copies/mL,it＇s suggested to choose Cesarean section. Key words：Hepatitis B virus ; Mother-to-child transmission; Delivery mode