Chronic hepatitis B in pregnant women: Current trends and approaches

Chronic hepatitis B(CHB)is a significant public health problem worldwide.The aim of the present review is to summarize the actual trends in the management of CHB in pregnant women.The prevalence of hepatitis B virus(HBV)infection in pregnant women is usually comparable to that in the general population in the corresponding geographic area.All women have to be screened for hepatitis B surface antigen(HBsAg)during pregnancy.Additional examinations of pregnant women with CHB may include maternal hepatitis B e antigen,HBV viral load,alanine aminotransferase level,and HBsAg level.The management of pregnancy depends on the phase of the HBV infection,which has to be determined before pregnancy.In women of childbearing age with CHB,antiviral therapy can pursue two main goals:Treatment of active CHB,and vertical transmission prevention.During pregnancy,tenofovir is the drug of choice in both cases.A combination of hepatitis B immunoglobulin and vaccine against hepatitis B should be administered within the first 12 h to all infants born to mothers with CHB.In such cases,there are no contraindications to breastfeeding.

新生儿肺炎死亡病例中B族链球菌的检测

目的对北京儿童医院新生儿肺炎死亡病例进行B族链球菌(GBS)回顾性检测,旨在初步揭示GBS感染在新生儿重症肺炎中的地位。方法收集200例1953年到2004年间新生儿肺炎死亡病例(研究组)和34例非感染性疾病新生儿死亡病例(对照组)的尸检病理标本,提取石蜡组织DNA,通过PCR和Southernblot技术检测GBS特异性基因片断cfb基因。同时对所选病例的临床资料进行复习。结果(1)研究组200例中,PCR对GBS检出率为26%,Southernblot检出率为65%,检出率均明显高于对照组(PCR3%,χ2=8.82,P<0.01;Southernblot,18%,χ2=26.77,P<0.01)。(2)研究组中,年龄小于7d的病例(早发型)103例,年龄大于7d的病例(晚发型)97例,小于7d的患儿GBS检出率明显高于大于7d的患儿,其中PCR检出率在前者为37%,后者为13%(χ2=15.537,P<0.01),Southernblot检出率在前者为72%,后者为52%(χ2=4.37,P<0.05)。早发型阳性病例中,39%为早产儿(29/74)。(3)研究组中,75例有完整临床资料,其中35例可查到一项或多项与GBS感染有关的危险因素,如早产,低体重,胎膜早破,羊水异常等,GBS检测结果均为阳性。阳性病例中,早发型最常见的表现有青紫、窒息,呼吸困难,晚发型最常见的表现有咳喘,呼吸困难。对照组中,1例PCR检测阳性者患恶性畸胎瘤,其他5例仅Southernblot检测阳性者分别为核黄疸、肝癌、先天性无肛合并膀胱尿道瘘、新生儿自然出血、先天性低位无肛合并直肠会阴瘘患者。结论GBS是新生儿肺炎死亡病例中的重要病原,尤其在早发型肺炎病例中GBS感染占很大比重。Southernblot是在石蜡标本中检测GBS的较为敏感方法。