慢性乙型肝炎病毒感染孕妇及其婴幼儿随访管理研究

Followed-up and m anagement of pregnant women with chronic hepatitis B viral infection

目的探讨针对慢性乙型肝炎病毒感染孕妇及其婴幼儿进行规范、科学、合理的随访管理模式。方法 2012年9月～2017年9月我科门诊或住院的乙型肝炎病毒感染孕妇1103例及其婴幼儿456名,成立乙型肝炎母婴传播阻断随访管理专家团队,开设乙型肝炎母婴传播阻断指导专家门诊,通过发放自制的乙型肝炎防治知识认知调查表和健康知识需求调查表进行调查。结果 32.28%孕妇可以接受母乳喂养,44.33%孕妇认为可以考虑自然分娩,多数人认为采取刨宫产可以减少乙型肝炎病毒母婴传播;41.89%孕妇认为孕期使用抗病毒药物是安全的,但也有担心抗病毒药物会对婴儿远期的生长发育产生不良影响;在1103例孕妇中,干预前对乙型肝炎知识和母婴传播阻断知识知晓率分别为59.11%和47.69%,依从性为77.61%,经采取一系列的干预措施,分别被提高到83.86%、79.69%和93.20%(P<0.05),满意度为89.66%;在456名全程参与乙型肝炎母婴传播阻断随访管理的婴幼儿中,2例(0.44%)婴儿在6月时血清HBs Ag阳性,提示母婴传播阻断成功率为99.56%(454/456)。结论建立规范、科学、合理、人文和全程全面的随访管理体系,可以提高乙型肝炎母婴传播阻断成功率,以努力实现乙型肝炎病毒母婴"零"传播。

Objective To build up a scientific and appropriate followed-up and management model for pregnant women with chronic hepatitis B viral infection to block mother to infant communication. Methods1103 pregnant women with hepatitis B viral infection and 456 infants were followed-up in our Department of Infectious Diseases,First Affiliated Hospital,Xi’an JiaoTong University between September 2012 and September2017,and a expert team was responsible for the management of them. We made up two questionnaire on hepatitis B-related knowledge and health demand knowledge and the corresponding intervention measures were taken for them. Results 32.28% of pregnant women accepted breastfeeding,44.33% of them considered natural labor,while most people thought that cesarean delivery might reduce mother to infant transmission of hepatitis B virus infection;41.89% of them accepted antiviral therapy during pregnancy and some worried about the nucleos(t)ide analogues might have a negative impact on the baby growth; out the 1103 pregnant women,the awareness rates of hepatitis B and mother-to-infant transmission knowledge before our intervention were 59.11% and 47.69%,the obedience was 77.61%,while they increased to 83.86%,79.69% and 93.20%(P<0.05) after our education with the satisfactory rate reaching to 89.66%;out of 456 infants who followed the entire the management,2(0.44%) got serum HBsAg positive at age of six months,suggesting the successful blockage of mother to infant transmission in our series was 99.56%(454/456). Conclusion The establishment of standardized, scientific,reasonable and cultural followed-up and management scheme might increase the successful blockage of mother to child hepatitis B viral transmission,and achieve a"zero"transmission goal.