摘要
目的 探讨不同喂养方式对乙型肝炎病毒(hepatitis B virus,HBV)母婴传播的影响. 方法 2010年12月1 8日至2012年6月26日,在首都医科大学附属北京地坛医院分娩的慢性HBV感染产妇中,纳入足月单胎妊娠者,根据产妇意愿分为母乳喂养组和人工喂养组.每组根据孕妇分娩前血清HBV-DNA载量进一步分为3个亚组:HBV-DNA阴性(<5×10^2拷贝/ml)、低病毒载量(≥5×10^2-<1×10^6拷贝/ml)和高病毒载量(≥1×10^6拷贝/ml).母乳喂养组共199例,3个亚组各73、62和64例;人工喂养组共210例,3个亚组各74、62和74例.新生儿出生2h内和15-30 d注射乙肝免疫球蛋白,并按“0、1、6月”方案正规接种重组酵母乙肝疫苗.采用荧光定量聚合酶链反应技术检测HBV-DNA.采用微粒子化学发光法检测HBV血清学标记物.比较母乳喂养组与人工喂养组的基本情况,及婴儿1月龄和7月龄时的免疫应答情况、7月-2岁时的感染情况.采用独立样本t检验、秩和检验、χ^2检验、Fisher精确概率法进行统计分析. 结果 HBV-DNA阴性、低病毒载量和高病毒载量的母乳喂养组与人工喂养组的乙肝e抗原阳性率分别为12.3%(9/73)与5.4%(4/74)、37.1%(23/62)与51.6%(32/62)、96.9%(62/64)与95.9%(71/74),差异均无统计学意义(P值均> 0.05).409例婴儿中,70例7月龄时未复查,但均在1-2岁时进行复查.HBV-DNA阴性、低病毒载量和高病毒载量的母乳喂养组与人工喂养组婴儿7月龄时乙肝表面抗体阳性率分别为98.4%(61/62)与100.0%(63/63)、98.2%(54/55)与98.2%(56/57)、95.7%(44/46)与92.9%(52/56),差异均无统计学意义(P值均>0.05).母乳喂养组与人工喂养组婴儿感染率分别为3.0%(6/199)与2.4%(5/210).HBV-DNA阴性组无婴儿感染;低病毒载量、高病毒载量的母乳喂养组与人工喂养组婴儿感染率分别为0.0%(0/62)与1.6%(1/62)、9.4%(6/64)与5.4%(4/74),差异均无统计学意义(P值均>0.05). 结论 在联合免疫的前提下,慢性HBV感染产妇采用母乳喂养不增加婴儿感染风险.
Objective To explore the effect of different feeding patterns on mother-to-child transmission of hepatitis B virus (HBV).Methods Chronic HBV-infected puerperae,who gave birth to a single baby at term in Beijing DiTan Hospital from December 18,2010 to June 26,2012,were recruited and separated into breast-feeding group and formula-feeding group according to the mother's will.Each group was then divided into three subgroups based on matemal serum HBV-DNA load before delivery:HBV-DNA negative subgroup (〈 5 × 10^2 copies/ml),low viral load subgroup (≥ 5 × 10^2-〈 1.0 × 10^6 copies/ml) and high viral load subgroup (≥ 1.0 × 10^6 copies/ml).A total of 199 patients in breast-feeding group were divided into three subgroups,separately including 73,62 and 64 patients,while a total of 210 patients in formula-feeding group into three subgroups,including 74,62 and 74 patients.Newborns were injected with Hepatitis B hyper-immune globulin (HBIG) within 2 h after birth and at 15 to 30 days,followed by the routine injection of recombinant yeast derived Hepatitis B vaccine in accordance with the scheme of "0,1,6 months".HBV-DNA was determined by fluorescence quantitative polymerase chain reaction,while serological markers of HBV by microsome chemiluminescence method.Comparisons were made between the breast-feeding and formula-feeding group on maternal background information,immune responses of the infants at one-month and seven-month old,the infectious status when they were between seven-month to two-year old.Statistical analysis was made with independent sample t-test,rank-sum test,χ^2 test and Fisher's exact test.Results The HBeAg positive rates of puerperae in the three subgroups (HBV-DNA negative,low viral load and high viral load) among women of the breast-feeding group were 12.3% (9/73),37.1% (23/62) and 96.9%(62/64),respectively,while 5.4% (4/74),51.6% (32/62) and 95.9% (71/74) among the formula-feeding group.There was no significant difference between breast-feeding group and formula-feeding group (all P 〉 0.05).Seventy of the 409 infants missed the follow-up at seven-month old,but returned between one to two years old.The anti-HBs positive rates of the three subgroups in infants of the breast-feeding group at seven-month old were 98.4% (61/62),98.2% (54/55) and 95.7% (44/46),while 100.0% (63/63),98.2% (56/57) and 92.9% (52/56) in the formula-feeding group (all P 〉 0.05).The infection rate of infants in the breast-feeding group and the formula-feeding group were 3.0% (6/199) and 2.4% (5/210) at seven-month to two-year old.Notably,infected infants was identified in HBV-DNA negative subgroup in neither the breast-feeding group nor the formula-feeding group,while 0.0% (0/62) and 9.4% (6/64) of infection rate were reported in low viral load and high viral load subgroups of the breast-feeding group and 1.6% (1/62) and 5.4% (4/74) of the formula-feeding group (both P 〉 0.05).Conclusion With combined immunization,breast-feeding in chronic HBV infected mothers does not increase the risk of infantile infection.
出处
《中华围产医学杂志》
CAS
CSCD
2015年第8期616-620,共5页
Chinese Journal of Perinatal Medicine
基金
首都医科大学附属北京地坛医院科研基金(YN2011-01)
关键词
乙型肝炎
慢性
传染性疾病传播
垂直
母乳喂养
喂饲方法
Hepatitis B, chronic
Infectious disease transmission, vertical
Breast feeding
Feeding methods