甘肃省靖远县住院分娩孕产妇乙型肝炎检测现况及分娩方式分析

Analysis of hepatitis B status and delivery mode of hospitalized pregnant women in Jingyuan county,Gansu province

目的了解甘肃省靖远县不同助产机构乙型肝炎表面抗原(HBsAg)阳性孕产妇产前乙型病毒性肝炎(简称乙肝)血清标志物检测情况及分娩方式现状。方法选择2016年10月1日—2017年10月31日所有助产机构中HBsAg阳性住院分娩孕产妇167例作为研究对象,采取面对面的现场调查方式收集调查对象的基本情况,通过查阅HBsAg阳性住院分娩孕产妇住院病历了解乙型肝炎血清标志物检测现况、孕期注射乙肝免疫球蛋白(HBIg)及抗病毒治疗情况。采用多因素Logistic回归分析不同年龄、文化程度、职业、首次HBsAg检出阳性至住院分娩时间、助产机构对分娩方式的影响。结果2016年10月1日—2017年10月31日住院分娩孕产妇共5991人,其中HBsAg阳性167例、阳性率2.79%,乙肝包膜抗原(HBeAg)阳性45例、占26.95%,3家助产机构(靖远县妇幼保健院、靖远县人民医院、靖远县中医院)HBeAg阳性率差异无统计学意义(χ^(2)=0.368,P>0.05);HBsAg阳性孕产妇检测乙肝病毒DNA(HBV DNA)17例、检测率10.18%,HBV DNA阳性11例、阳性率64.71%;3家助产机构HBsAg阳性住院分娩孕产妇丙氨酸氨基转移酶(ALT)检测率分别为66.67%(58/87)、38.89%(21/54)、23.08%(6/26),差异有统计学意义(χ^(2)=19.824,P<0.05),HBsAg阳性孕产妇孕期HBIg注射率差异有统计学意义(Fisher确切概率法,P=0.000)。Logistic回归分析显示不同年龄、文化程度、职业、首次HBsAg检测阳性至住院分娩时间和助产机构与分娩方式无关。结论靖远县不同助产机构孕产妇的乙肝产前检测工作亟待加强和规范,提高HBsAg阳性孕产妇乙肝血清标志物检测率和HBIg注射率,以阻断乙肝母婴传播。

Objective To understand the detection of hepatitis B and the delivery mode of pregnant women with positive hepatitis B surface antigen(HBsAg)in different midwifery institutions in Jingyuan county,Gansu province Methods There were 167 hospitalized pregnant women with HBsAg positive selected as the research objects in all midwifery institutions from October 1,2016 to October 31,2017.The information of the pregnant women was collected with face-to-face interview in the field investigation.The status of hepatitis B serum markers detection,hepatitis B virus immunoglobline(HBIg)injection and antiviral treatment during pregnancy were collected by looking up the medical records of the pregnant women with HBsAg positive in the midwifery institutions for delivery.Multiple factors logistic regression was used to analyze the effects of different age,education level,occupation,the time from first detection of HBsAg positive to the delivery in hospital and the different midwifery institutions to the selection of delivery mode.Results From October 1,2016 to October 31,2017,a total of 5991 pregnant women gave birth in hospital,including 167 HBsAg positive cases,with positive rate of 2.79%;There were 45 hepatitis b envelope antigen(HBeAg)positive cases,accounting for 26.95%,and there was no statistically difference(χ^(2)=0.368,P0.05)in the positive rates of HBeAg in 3 midwifery institutions(Jingyuan Maternal and Child Health Hospital,Jingyuan People's Hospital and Jingyuan Hospital of Traditional Chinese Medicine).HBV DNA was detected in 17 cases of HBsAg positive pregnant women,the detection rate was 10.18%,and HBV DNA was positive in 11 cases,the positive rate was 64.71%;The alanine aminotrans ferase(ALT)detection rates of HBsAg positive pregnant women in the three midwifed institutions were 66.67%(58/87),38.89%(21/54)and 23.08%(6/26),respectively,and the difference was statistically significant(χ^(2)=19.824,P0.05).There was statistical difference in the HBIg injection rates among HBsAg positive pregnant women during pregnancy(Fisher exact probability method,P=0.000).Logistic regression analysis showed that different age,educational level,occupation,time of delivery from first HBsAg positive test to hospitalization and midwifing institution were not associated with delivery mode.Conclusions The detection of hepatitis B before the delivery of pregnant women in different midwifery institutions needs to be strengthened and normalized to improve the detection rate of hepatitis B serum markers and the HBIg injection rate in HBsAg positive pregnant women for blocking mother-to-child transmission of hepatitis B in Jingyuan county.