234名HBsAg阳性产妇乙型肝炎病毒母婴传播情况及影响因素研究

Mother-to-child transmission of hepatitis B virus and its influencing factors in 234 HBsAg positive parturients

【目的】研究乙型肝炎病毒(HBV)母婴传播情况及其影响因素,为乙肝防治工作提供依据。【方法】在上海市浦东新区妇幼保健院招募234名乙肝病毒表面抗原(HBsAg)阳性产妇开展流行病学问卷调查,分别采集母亲外周血和新生儿脐带血检测乙肝血清学指标及HBV DNA水平。新生儿脐带血HBsAg阳性且HBV DNA阳性者定义为新生儿HBV阳性。对65名新生儿出生后随访到7月龄,采集血样进行乙肝血清学与HBV DNA水平检测。【结果】HBsAg阳性产妇所生新生儿HBV阳性率为7.7%。产妇乙肝病毒e抗原(HBeAg)阳性和HBV DNA高浓度是HBV母婴传播的影响因素。产后7个月婴儿HBV阳性率为1.5%。【结论】应加强HBsAg、HBeAg均为阳性以及HBV DNA浓度较高孕产妇的孕期管理,开展HBV感染的治疗与干预;对HBsAg阳性孕产妇的新生儿进行24 h内的主、被动联合免疫,减少婴儿的HBV感染风险。

[Objective]To study the transmission of hepatitis B virus(HBV)from mother to child and the related impact factors.[Methods]An epidemiological questionnaire was conducted on 234 participants with positive HBsAg from Shanghai Pudong Health Care Hospital for Women and Children.Bloods samples were collected to detect the markers and DNA titer of HBV.HBsAg positiveness and HBV DNA positiveness in umbilical cord blood was defined as neonatal HBV positiveness.A series of 65 newborn babies were followed up from birth to 7 months,and the collection of blood samples and the detection of the markers and DNA titer of HBV were performed.[Results]The positive rate of intrauterine HBV was 7.7%.Maternal HBeAg positivity and high concentration of HBV DNA were the influencing factors of HBV mother-to-child transmission.The immune failure rate of hepatitis B vaccine after 7 months of newborns was 1.5%.[Conclusion]It is imperative to strengthen pregnancy management for maternal with positive HBsAg,positive HBeAg,and high concentration of HBV DNA,carrying out treatment and intervention of HBV infection.For HBsAg positive maternal newborns should be done active and passive immunization within 24 h,so as to reduce the risk of HBV infection in infants.