指导HBsAg阳性产妇母乳喂养的策略

Instruction on breast-feeding with hepatitis B virus markers positive mothers

目的 :探讨影响HBsAg阳性产妇母乳喂养的因素及指导母乳喂养的相关实验室和临床依据。方法 :用ELISA法检测孕妇和婴儿 ( 12～ 18个月 )血清中的乙型肝炎标志物 (HBVM) ,用荧光定量PCR法检测HBV携带产妇血清和初乳中HBV-DNA含量 ,并对孕妇和婴儿进行全程免疫防护 ,然后分析婴儿血清HBVM与母乳喂养和人工喂养的关系。结果 :6 7例HB sAg阳性 (大、小三阳 )产妇中 ,HBV血清‘大三阳’的产妇血液、初乳中HBV -DNA阳性率较高 ,分别为 84 %和 2 6 %。母亲血清HBVM为‘大三阳’者分别占人工喂养组和母乳喂养组的 4 1%和 13% ,两组间差异有显著性 (P <0 .0 5 ) ;婴儿在 12～ 18个月时作血清HBVM检测 ,人工喂养组和母乳喂养组婴儿血清抗 -HBs阳性率分别为 84 %和 87% ,两组差异无显著性 (P >0 .0 5 )。结论 :HBV携带产妇只要在孕期进行预防干预及对所产婴儿进行被动和主动免疫防范措施 ,当产妇乳汁中HBV

Objective:To provide a correlation evidence in laboratory for instruction breast-feeding,the investigation of positive rates with serum hepatitis B virus markers(HBVM) in parturients and their infants of breast-feeding to HBVM antigen positive mothers.Methods:The serum HBVM of pregnant women and their infants(12～18th month)were determined by ELISA and HBV-DNA in positive serum and colostrum were determined by fluorescence quantitative PCR,and whole process of immune-protection for pregnant women and their infants.The relation between HBVM in the infant serum and the feeding way was analysed.Results:In 67 case parturient of serum HBVM antigen positive,the positive rate of HBV-DNA was 84%,26% in serum and colostrum with HBeAg positive and HBeAg negative mothers;and there was a positive relationship between the serum and colostrum.The positive rate of HBeAg of serum mothers were 41% and 13% in the artificial feeding group and breast feeding group,there was significant difference between them( P <0.01).After 12～18 months,the infants positive rate of serum anti-HBs was 84% and 87% in the artificial feeding group and breast feeding group( P >0.05).Conclusion:As determinations of HBV-DNA were negative in colostrum,the breast-feeding was safe to HBVM antigen positive mothers by active and passive immunization with pregnant women and their infants.