贵州省孕妇乙型肝炎病毒感染现状分析

Analysis on the current situation of hepatitis B virus infection among pregnant women in Guizhou province

目的了解贵州省孕妇乙型肝炎病毒（HBV）的感染状况。方法采用分层随机抽样的方法，随机抽取4个市州，在4个市州中随机抽取9个县级医院作为调查单位，对调查单位内2014年1月-2015年12月期间住院分娩的孕妇开展乙肝病毒表面抗原（Hepatitis B Surface Antigen，HBsAg）筛查，对HBsAg阳性的孕妇开展问卷调查并采集血标本，分离血清后用酶联免疫吸附试验（ELISA）检测HBsAg、抗乙肝病毒表面抗原抗体（Anti-hepatitis B Surface Antibody，Ami-HBs）、抗乙肝病毒核心抗原抗体（Anti-hepatitis B CoreAntibody，Anti—HBc）。对HBsAg阳性标本进行乙肝病毒e抗原（Hepatitis B e Antigen，HBeAg）和抗乙肝病毒e抗原抗体（Anti—hepatitis B e Antibody，Anti—HBe）。结果共筛查9个县18007名孕妇，HBsAg阳性561例，经ELISA方法复测HBsAg阳性517例，孕妇HBV感染率为3．08％，HBsAg阳性率为2．87％。9个县孕妇HBsAg阳性率1．82％。9．32％，HBV感染率1．89％-9．79％，HBeAg阳性率0．81％～3．00％，经χ^2检验差异有显著性（P〈0．05）。9个县孕妇HBsAg阳性率、HBV感染率、HBeAg阳性率均是黎平县最高。孕妇HBV感染的HBVM模式有20种，以HBsAg、HBeAg和Anti—HBc阳性（大三阳），HBsAg、Anti—HBe、Anti—HBc阳性（小三阳）占总感染孕妇数的65．10％；调查的561例孕妇中，64例有乙肝疫苗免疫史，占11．40％，无免疫史的346例，占88．60％。结论贵州省孕妇存在HBV感染，以小三阳、大三阳感染模式最多见，孕妇乙肝疫苗接种比例不高，建议贵州省在加强乙肝疫苗常规免疫的同时，应对15～30岁妇女开展乙肝疫苗补充免疫，提高贵州省育龄妇女乙肝疫苗覆盖率，进一步降低孕妇HBsAg阳性率，减少HBV的垂直传播。

Objective .To understand the infection status of hepatitis B virus （HBV） among pregnant women in Guizhou province. Methods Four cities （prefectures） were randomly selected by stratified random sampling method, then nine hospitals at county level were randomly selected from four cities （prefectures） . The pregnant women giving birth to their babies in the hospitals from January 2014 to December 2015 received hepatitis B surface antigen （HBsAg） screening, the pregnant women with positive HbsAg were surveyed by a questionnaire, blood specimens were abstracted, ELISA was used to detect HBsAg, anti-hepatitis B surface antibody （anti-HBs）, anti-hepatitis B core antibody （anti-HBe）, hepatitis B e antigen （HBeAg）, and anti-hepatitis B e antibody （anti-HBe） after serum separation. Results A total of 18 007 pregnant women were screened in nine counties, 561 pregnant women were found with positive HbsAg, 517 pregnant women were found with positive HbsAg by ELISA, the infection rate of HBV was 3.08% , the positive rate of HbsAg was 2. 87%. The positive rate of HbsAg among pregnant women in nine counties ranged from 1.82% to 9. 32% , the infection rate of HBV ranged from 1. 89% to 9. 79%, the positive rate of HBeAg ranged from 0. 81% to 3.00% , there was statistically significant difference （P〈0. 05 ） . Among the pregnant women in nine counties, the positive rate of HbsAg, infection rate of HBV, positive rate of HbeAg among the pregnant women in Liping county were the highest. HBVM modes of HBV infeeton among pregnant women were 20 kinds, the pregnant women with positive HBsAg, HbeAg, anti-HBc and the pregnant women with positive HBsAg, anti-HBe, anti-HBe accounted for 65. 10% of the total pregnant women with HBV infection. Among 561 pregnant women, 64 pregnant women had the history of hepatitis B vaccine, accounting for 11.40% ; 346 pregnant women didb＇t have the history of hepatitis B vaccine, accounting for 88. 60%. Conclusion HBV infection exists among some preg- nant women in Guizhou province, positive HBsAg, HbeAg, anti-HBe and positive HBsAg, anti-HBe, anti-HBc are two common infection modes, the proportion of pregnant women receiving hepatitis B vaccination among pregnant women is not high. It is recommended that at the same time of enhancing routine immunization of hepatitis B vaccine in Guizhou province, supplementary immunization of hepatitis B vaccine should be conducted among the women aged 15-30 years old to improve the coverage rate of hepatitis B vaccine among women of childbearing age, further reduce positive rate of HBsAg among pregnant women and vertical transmission of hepatitis B vaccine.