不同分娩方式对乙型肝炎病毒母婴垂直传播的影响

The effect of delivery mode on materal-infant transmission of hepatitis B virus

目的:探讨不同分娩方式对乙型肝炎病毒母婴垂直传播的影响。方法:收集在暨南大学附属第一医院正规产检并且足月分娩的乙肝表面抗原阳性孕妇68例(乙肝组)及同期分娩的乙肝表面抗原阴性孕妇64例(对照组)。乙肝组分别检测不同分娩方式临产前母血乙肝病毒标记物、胎盘型碱性磷酸酶、HBV-DNA含量;同时采集脐带血检测胎盘型碱性磷酸酶及HBV-DNA含量,采集新生儿出生后1天内外周血检测乙肝病毒标记物及HBV-DNA含量。对照组分别在临产前及分娩后采集孕妇外周血及脐带血定量检测胎盘型碱性磷酸酶。结果:乙肝组和对照组的选择性剖宫产胎儿脐血中胎盘型碱性磷酸酶含量均低于顺产组,差异有统计学意义(P<0.05)。乙肝组不同分娩方式的新生儿外周血HBV-DNA、HBsAg均为阴性,HBeAg阳性率差异无统计学义(P>0.05)。结论:选择性剖宫产比顺产更能减少母血向胎儿血的渗透量。

Objective： To discuss the effect of delivery mode on materal-infant transmission of hepatitis B virus. Method： Collect the Hbs Ag-positive gravidas who take the systematic antenatal examination and deliver at term in the first affiliated hospital of Jinan University as hepatitis B group,68 cases in totol,and 64 Hbs Ag-negative cases at the same period as control group. In the hepatitis B group,collect materal venous blood before labor to test HBV-Ms,placental alkaline phosphatase（ PLAP） and HBV-DNA,cord blood to test PLAP and HBVDNA,infant venous blood in 24 hours since birth to test HBV-Ms and HBV-DNA. In the control group,collect materal venous blood before labor and cord blood to test PLAP. Result： In both hepatitis B group and control group,selected cesarean section has the lower PLAP in cord blood than vaginal delivery（ P〈 0. 05）. In hepatitis B group,HBV-DNA、HBsAg in infant venous blood was all negtive in both two delivery mode,the positive rate of HBeAg has no significant difference（ P〉 0. 05）. Conclusion： Selected cesarean section can reduce the penetration from materal blood to infant blood.