高病毒载量HBsAg阳性孕妇HBV母婴传播的多因素分析

Multivariate analysis and control strategy of mother to child transmission of HBV in HBsAg positive pregnant women with high viral load

目的探讨高病毒载量乙肝孕妇发生母婴传播的危险因素,为完善乙肝母婴阻断策略提供科学依据。方法回顾性收集石家庄市妇幼保健院和石家庄市第五医院高病毒载量(HBV DNA≥2×10^(5) U/ml)乙型肝炎病毒(HBV)感染孕妇的资料,根据入排标准筛选并分为TDF组、TBV组和对照组,对各种可能导致HBV母婴传播的因素进行单因素分析及多因素logistic回归分析,分析危险因素及控制策略。结果共纳入545例孕妇,分娩545例婴儿,其中TDF组174例,TBV组331例,对照组40例。TDF组与TBV组HBV母婴传播率均低于对照组,差异均有统计学意义(P<0.05)。3组孕妇ALT升高率、CK升高率等差异无统计学意义(P>0.05),新生儿无畸形等严重不良事件发生。单因素分析结果显示孕妇分娩时HBV DNA水平和孕期是否接受抗病毒治疗是发生HBV母婴传播的影响因素(P<0.05),多因素logistic回归分析显示分娩时HBV DNA水平是发生母婴传播的危险因素(P=0.007)。分娩时HBV DNA水平多因素线性回归分析显示其受基线HBV DNA水平、抗病毒治疗和抗病毒治疗时间影响。在TDF组中,孕中期服药组分娩时HBV DNA水平显著低于孕晚期服药组(P<0.001),但TBV组差异无统计学意义(P>0.05)。结论高病毒载量乙肝孕妇分娩时HBV DNA高水平是导致免疫失败的主要原因,孕期接受抗病毒治疗可有效降低孕妇分娩时HBV DNA水平,提高母婴阻断成功率且安全性良好。孕中期服用TDF降低分娩时HBV DNA水平效果显著。因此,强烈推荐孕中期服用TDF进行抗病毒治疗以预防母婴传播。

Objective To investigate the risk factors of mother to child transmission(MTCT)in pregnant women with high viral load of hepatitis B,and to provide a scientific basis for consummating the strategy of interruption.Methods The clinical data of pregnant women infected by high viral load hepatitis B virus(HBV DNA≥2×10^(5) U/ml)who were treated in our hospital were retrospectively collected,and the patients were divided into TDF group,TBV group and control group according to the related criteria.The various factors related with MTCT were analysed by single factor analysis and multivariate logistic regression analysis to find the risk factors and control strategies.Results A total of 545 pregnant women were enrolled,who deliveried 545 infants,including 174 cases in TDF group,331 cases in TBV group,40 cases in control group.The MTCT rates of HBV in TDF group and TBV group were significantly lower than those in control group(P<0.05).There were no statistical differences in increase rates of ALT and CK among the three groups(P>0.05).Univariate analysis showed that HBV DNA levels at delivery and whether the pregnant women received antiviral therapy during pregnancy were the influential factors of MTCT of HBV(P<0.05).The multivariate Logistic regression analysis showed that the HBV DNA levels at delivery were risk factor for MTCT(P<0.01).Multivariate linear regression analysis showed that HBV DNA levels,and antiviral treatment time were risk factor for MTCT(P<0.01).And the HBV DNA levels in pregnant metaphase medication group were significantly lower than those in pregnant last trimester medication(P<0.001),however,there were no significant differences in TBV(P>0.05).Conclusion The high levels of HBV DNA during delivery in pregnant women with high viral load HBV are the main cause of immune failure.Antiviral therapy during pregnancy can effectively reduce the level of HBV DNA during delivery,and improve the success rate of interrupting MTCT,with high good safety.Taking TDF in the pregnant metaphase has significant effects in reducing HBV DNA levels at delivery.Therefore,it is necessary to perform antiviral treatment with TDF during the pregnant metaphase to prevent MTCT.