HBV孕妇新生儿宫内感染的影响因素研究

Study on the influencing factors of intrauterine infection in the newborns of the pregnant women with hepatitis B

目的研究和分析乙肝孕妇新生儿乙型肝炎病毒(HBV)宫内感染的影响因素,为预防和控制感染性疾病提供客观依据。方法选取2016年10月-2018年1月的医院收治的136例乙肝孕妇为研究对象,对其新生儿脐带血中的乙肝表面抗原(HBsAg)、乙肝e抗原(HBeAg)、乙肝e抗体(HBeAb)阳性、乙肝核心抗体(HBcAb)阳性率进行检测,分析HBV宫内感染的发生率,对HBV宫内感染的早孕反应、孕期腹痛史、阴道流血史、流产史、胎儿窘迫、胎膜早破、羊水情况、分娩方式、新生儿性别等相关影响因素进行观察和分析。结果有41例新生儿发生HBV宫内感染,感染率为30.15%,其中,以HBeAb和HBcAb双阳性为主,为18例占43.90%,其次为HBsAg和HBcAb双阳性占19.51%、HBcAb阳性占14.63%;单因素分析结果显示,居住地、病情、阴道流血史、羊水情况与乙肝孕妇新生儿发生HBV宫内感染有关(P<0.05);Logistic多元回归分析结果显示,乙肝孕妇新生儿发生HBV宫内感染的影响因素为阴道流血史、大三阳或小三阳、羊水浑浊(P<0.05)。结论乙肝孕妇新生儿HBV宫内感染的发生与阴道流血史、羊水状态及乙肝病情程度有关,临床医生应给予积极的预防和控制,以降低新生儿的HBV感染风险。

OBJECTIVE To study and analyze the influencing factors of hepatitis B virus（HBV）intrauterine infection in the newborns of the pregnant women with hepatitis B,so as to provide objective basis for prevention and control of infectious diseases.METHODS 136 cases of pregnant women with hepatitis B treated in our hospital from Oct.2016 to Jan.2018 were selected as the research subjects.The positive rates of HBV surface antigen（HBsAg）,HBV e antigen（HBeAg）,HBV e antibody（HBeAb）,HBV core antibody（HBcAb）in the umbilical cord blood of the newborns were detected,to analyze the incidence of HBV intrauterine infection.And the related factors of HBV intrauterine infection such as early pregnancy reaction,abdominal pain history,vaginal bleeding history,abortion history,fetal distress,premature rupture of membranes,amniotic fluid,delivery mode,and sex of newborn were observed and analyzed.RESULTS There were 41 cases of newborns with HBV intrauterine infection,and the infection rate was 30.15%,dominated by HBeAb and HBcAb double positive,HBsAg and HBcAb double positive,and HBcAb positive,accounting for 43.9%,19.51% and 14.63% respectively.Univariate analysis showed that the incidences of HBV intrauterine infection in the newborns of the pregnant women were related with the place of residence,severity of illness,vaginal bleeding history and amniotic fluid situation（P〈0.05）.Logistic multivariate regression analysis showed that the incidence of HBV intrauterine infection in the newborns of the pregnant women with hepatitis B was correlated with vaginal bleeding history,serious triple positive results or the mild triple positive results,and amniotic fluid turbidity（P〈0.05）.CONCLUSION The incidence of HBV intrauterine infection is related to the history of vaginal bleeding,the condition of amniotic fluid and the severity of hepatitis B.The clinicians should take active prevention and control measures to reduce the risk of HBV infection in newborns.