乙肝疫苗联合乙肝免疫球蛋白阻断乙肝病毒垂直传播失败的相关危险因素分析

Analysis of Risk Factors Related to the Failure of Hepatitis B Vaccine Combined With Hepatitis B Immunoglobulin in Preventing Vertical Transmission of Hepatitis B Virus

目的探究乙肝疫苗联合乙肝免疫球蛋白阻断乙肝病毒垂直传播失败的相关危险因素分析。方法对2015年2月—2018年1月医院收治的HBV感染的待产妇采用乙肝疫苗联和乙肝免疫球蛋白进行HBV垂直传播阻断,根据年龄、入院时间选取阻断失败孕妇和成功阻断孕妇各120例,分别命名为失败组和成功组。对两组孕妇的个人资料、疾病情况和孕期情况进行单因素分析和多因素logistic回归分析。观察乙肝疫苗联合乙肝免疫球蛋白阻断乙肝病毒垂直传播失败的相关危险因素。结果妊娠期高血压(OR=1.624,95%CI=0.642～5.359)、妊娠期糖尿病(OR=4.630,95%CI=0.419～12.627)、产程(OR=2.200,95%CI=1.639～5.980)、HBV水平(OR=9.223,95%CI=4.058～33.598)、分娩方式(OR=2.309,95%CI=1.093～9.277)、羊水胎粪污染(OR=8.641,95%CI=1.029～19.336)、胎膜早破(OR=7.144,95%CI=4.100～19.207)可能是HBV垂直传播阻断失败的独立危险因素,且均与HBV阻断失败发生率呈正相关。结论HBV感染的待孕妇女应在受孕前积极进行抗病毒治疗,孕中加强高血压、糖尿病的预防,如无特殊情况尽量选择顺产。

Objective To investigate the risk factors associated with thefailure of hepatitis B vaccine combined with hepatitis B immunoglobulinto block the vertical transmission of hepatitis B virus. Methods FromFebruary 2015 to January 2018 in our hospital, HBV-infected pregnantwomen admitted to our hospital were treated with hepatitis B vaccine andhepatitis B immunoglobulin for vertical transmission of HBV. Accordingto the age and hospital admission time, 120 pregnant women were namedas failed group and successful group. Univariate analysis and multivariatelogistic regression analysis were used to analyze the personal data, diseasestatus and pregnancy status of the two groups of pregnant women. Toinvestigate the risk factors for failure of hepatitis B vaccine combined withhepatitis B immunoglobulin in blocking vertical transmission of hepatitisB virus. Results Gestational hypertension （OR=1.624, 95%CI=0.642 ~5.359）, gestational diabetes mellitus （OR=4.630, 95%CI=0.419 ~ 12.627）,labor （OR=2.200, 95%CI=1.639 ~ 5.980）, HBV （OR=9.223, 95%CI=4.058~ 33.598）, mode of delivery （OR=2.309, 95%CI=1.093 ~ 9.277）, amnioticfluid meconium-stained （OR=8.641, 95%CI=1.029 ~ 19.336）. Prematurerupture of membranes （OR=7.144, 95%CI=4.100 ~ 19.207） may be anindependent risk factor for the failure of vertical transmission of HBV, andboth of them are positively correlated with the incidence of HBV blockfailure. Conclusion HBV-infected pregnant women should be activelytreated with antiviral therapy before conception. In pregnancy, hypertensionand diabetes should be prevented. If there is no special case, they shouldchoose natural delivery as far as possible.