Seroprevalence of hepatitis B surface antigen in pregnant women attending antenatal clinic in Honiara Solomon Islands,2015

AIMTo determine the seroprevalence of hepatitis B surface antigen (HBsAg) among pregnant women attending antenatal clinic in Honiara, Solomon Islands. METHODSThis descriptive cross-sectional study was carried out in seven area health centers in Honiara. From March to June 2015, identification of eligible pregnant women in each site was conducted using systematic random sampling technique. A total of 243 pregnant women who gave written informed consent were enrolled. Standardized tool was used to record demographics, obstetric history and serology results. HBsAg and hepatitis B e antigen (HBeAg) were tested using point-of-care rapid diagnostic test. All HBsAg positive samples were verified using enzyme-linked immunosorbent assay. RESULTSThe mean age of participants was 26 ± 6 years. The overall hepatitis HBsAg prevalence was 13.8% with higher rate (22%) reported in women between 30-34 years of age. Majority of HBsAg positive participants were Melanesians (29 out for 33). None of the pregnant women in the 15-19 years and ≥ 40 years tested positive for HBsAg. There was no statistically significant difference in HBsAg prevalence by age, ethnicity, education and residential location. The overall HBeAg seroprevalence was 36.7%. Women between 20-24 years of age had the highest rate of 54.5%. Low level of knowledge about hepatitis B vaccination was reputed. Overall, 54.6% of participants were not aware of their hepatitis B vaccination status and only 65.2% of mothers reported their child had been vaccinated. CONCLUSIONHepatitis B is a disease of public health importance in Solomon Islands and emphasize the need for integrated preventative interventions for its control.

Hepatitis B Infection and Immunity among Pregnant Women Attending Antenatal Clinics in Health Centers of Mbarara Municipality, Southwestern Uganda

Introduction: Viral hepatitis B (HBV) in pregnancy is a risk for childhood transmission where the majority become chronically infected. In Uganda, HBV is not tested for during antenatal, therefore the number of infected, infectious, immune and none-immune pregnant women is unknown curtailing efforts to prevent mother to child transmission. Methods: We conducted a descriptive cross-sectional study involving 254 pregnant women from four health centers in Mbarara Municipality. HBV status was assessed using an immunochromatographic (COMBO) kit, the type of infection;based on demonstration of anti hepB core IgM (acute infection) and total core IgG antibodies (chronic infection) and infectiousness;based on the presence of HBeAg and/or a quantitative HBV viral load ≥ 20,000 IU/mL. Immunity was determined using the COMBO kit and HBsAb quantification ELISA. One was deemed immune to HBV if HBsAb titers were ≥10 mIU/mL. Results: The prevalence of HBV infection was 1.2%;33% and 67% with acute and chronic HBV respectively. 33% were infectious based on a high viral load, none had detectable HBeAg. 14% were immune;amongst whom 72% had natural exposure and 18% after vaccination. There was insufficient immunity in 11% with a majority (75%) having acquired immunity following vaccination. Conclusion: The prevalence of HBV is low and most of those are chronically infected. HBeAg and Hepatitis B viral load should be performed when evaluating infectiousness. Further, there is a high transmission of HBV among adults and a low uptake of the HBV vaccine in Mbarara Municipality.

Epidemiology of hepatitis B virus infection in Albania

AIM： To assess the prevalence and socio-demographic distribution of hepatitis B virus （HBV） infection in Albania. METHODS： Blood samples from 410 unselected schoolboys, 666 students, 500 military personnel, 1286 casual blood donors, 378 voluntary blood donors and 640 pregnant women （total 3880 non-vaccinated residents of rural and metropolitan areas from all over Albania; 2354 （60.7%） male and 1526 （39.3%） female; mean age of 26.3 years） were tested during 2004-2006 for hepatitis B surface antigen （HBsAg） and antibodies to hepatitis B virus （anti-HBs） by ELISA. RESULTS： The HBsAg and anti-HBs prevalence were 9.5% and 28.7%, respectively. The highest HI3sAg prevalence was evident in the younger age group, such as in schoolchildren （11.8%） and the military （10.6%）. Consequently, the anti-HBs prevalence increased with age, from 21.2% in schoolchildren （mean age： 15.7 years）, to 36.3% in pregnant women （mean age： 26.3 years） and 29.7% in voluntary blood donors （mean age： 40.1 years）. There were no significant differences between males and females. CONCLUSION： Despite the estimated two-fold reduction of HBsAg prevalence in the general population from about 18%-19% to 9.5%, Albania remains a highly endemic country （i.e. over 8% of HBsAg prevalence rate）.

Optimal Control of Hepatitis B in a sub-Saharan African rural area

In this paper,we ameliorate the model proposed in[13],by incorporating the influence of hepatitis B e antigen(HBeAg)status of mothers on vertical transmission.We use the improved model to fit reported HBV new infections in the Zhejiang Province of China.Also to predict the course of the Hepatitis B(HBV)infection in this Chinese area,and in Tokombere,located in sub-Saharan Africa(SSA).Furthermore,we apply optimal control techniques in view to re-examine the effects of the newborn vaccination,the universal vaccination and the treatment of chronic carriers in preventing the HBV infection.Simulation results show that treatment slightly steps in the optimal strategy,while immunisation is an effective measure.On the other hand,they indicate that the control measures and immunization programs implemented in Zhejiang Province are effective.Besides,they suggest that in SSA,a package of several policies centred on birth dose vaccination should be implemented.

阻断HBV母婴传播:热点与难点

慢性HBV感染是我国最重要的公共卫生问题之一,HBV感染人群超过7000万,防控工作面临着严峻挑战。当前政府及社会各界正在加速推进“2030年实现消除病毒性肝炎对公众健康的威胁”的宏伟目标。母婴传播是HBV最主要的传播途径,因此,做好HBV母婴阻断是消除病毒性肝炎的关键一环。目前在该领域存在一些热点与难点问题亟需解决,包括妊娠期采用富马酸丙酚替诺福韦长期治疗的安全性、妊娠早期抗病毒治疗的安全性、无免疫球蛋白策略的有效性和HBV经生殖细胞传播的风险等,解决这些问题对进一步推进HBV母婴阻断工作,加快我国实现2030年目标的进程具有重要作用。

HBV高载量孕妇孕期抗病毒治疗结合标准阻断措施阻断母婴传播效果

目的:探究乙型肝炎病毒(HBV)高载量孕妇孕期HBV-DNA水平和乙型肝炎病毒e抗原(HBeAg)阳性情况,分析孕期抗病毒治疗结合标准阻断措施对HBV高载量孕妇母婴传播阻断效果。方法:回顾性收集2021年1月-2023年1月本院住院分娩的120例HBV高载量孕妇临床资料,分析孕妇妊娠期、分娩前HBV-DNA水平和HBeAg阳性率,多因素logistic回归分析HBeAg状态影响因素,分析孕期抗病毒治疗对新生儿乙肝母婴传播阻断效果及母婴安全性。结果:120例HBV高载量孕妇中,孕期接受抗病毒治疗93例(治疗组),抗病毒药物分别为替诺福韦占56.6%、拉米夫定占20.8%;未接受治疗27例(未治疗组)。妊娠期,抗病毒治疗组和未治疗组HBV-DNA载量、HBeAg阳性率无差异(P>0.05);分娩前,抗病毒治疗组HBV-DNA载量≥10^(6)IU/ml占比(7.5%)低于未治疗组(92.6%)(P<0.05),而两组HBeAg阳性率(90.3%、92.6%)无差异(P>0.05)。多因素logistic分析,年龄低、HBVDNA载量高影响HBeAg状态的独立危险因素(P<0.05)。新生儿乙肝母婴传播阻断率抗病毒治疗组(100.0%)高于未治疗组(2例,92.6%)(P<0.05)。两组新生儿体质量、早产、剖宫产、妊娠合并症、产时并发症比较无差异(P>0.05)。结论:HBV高载量孕妇HBV-DNA水平较高,HBeAg阳性率与孕妇年龄低、HBV-DNA载量高有关;孕期抗病毒治疗可降低孕妇分娩前HBV-DNA水平,结合标准阻断措施后可提高HBV母婴传播阻断率,且安全性较好。

Prevalence of the hepatitis B surface antigen in a population of workers in Cameroon

Hepatitis B surface antigen prevalence in populations of blood donors in Cameroon is estimated at 6%-16%. As such, the Objective of this study was to determine the prevalence of Hepatitis B surface antigen in a population of bank employees, who represent a sample closer to the general population. In tests carried out both Yaounde and Douala in December 2011, we detected the hepatitis B surface antigen among 267 workers, including 151 men and 116 women of a median age of 37 years. The Results obtained revealed that the overall prevalence stood at 7.1%, with a 9.9% prevalence ratio in men, three times higher than that in women (3.4%). Subjects aged 20-29 years and senior staffs were more affected (each of them recording 8.1%). Potential nosocomial risks were detected mostly at the level of dental care (52.8%). Among the other risks of exposure, scarification (53.6%) was more frequent. A univariate analysis revealed an insignificant relationship with tattoos (OR 2.6, 95% CI 0.5-10.8, p = 0.2). These results led to the Conclusion that Hepatitis B surface antigen carrier prevalence in a population of workers in Cameroon is not different from that of blood donors. It is mainly due to early vertical and horizontal contamination.

41例慢性HBV感染危重孕产妇的临床特征分析

目的分析慢性HBV感染的危重孕产妇临床特点及其转归,为救治危重孕产妇和防治肝病重症化提供临床经验。方法选取2013年3月—2023年3月南京市第二医院重症医学科收治的慢性HBV感染的孕产妇41例,通过医院电子病历系统收集孕产妇的临床资料,总结乙型肝炎孕产妇转入ICU的主要原因、死亡原因、治疗情况等。正态分布的计量资料两组间比较采用成组t检验;非正态分布的计量资料两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ^(2)检验。结果13例(31.71%)患者未正规产检,8例(19.51%)高病毒载量患者(HBV DNA≥2×10^(5)IU/mL)未接受抗病毒治疗。主要的分娩方式为剖宫产32例(78.05%),婴儿早产23例(56.10%),患者死亡5例(12.20%)。转入ICU的前3位病因分别为肝衰竭、产后大出血和妊娠高血压疾病。肝衰竭主要在孕晚期发病,最多见并发症为肝性脑病(28.57%),最多见合并症为妊娠期肝内胆汁淤积症(21.43%);6例(42.86%)产检规律;13例(92.86%)入院前未接受抗病毒治疗。产后大出血患者平均ICU住院时间为(3.31±1.65)d,其中合并重症肝病者分娩前出现凝血功能异常,治疗48 h仍难以纠正。结论慢性HBV感染的孕产妇病情复杂,病死率较高。评估肝脏状态、定期产检和及时行抗病毒治疗对减少慢性HBV孕产妇重症发病、降低病死率尤为重要。

HBsAg阳性孕妇及新生儿血清IL-6、IL.17、IL-23水平与HBV宫内感染关系

目的:探讨乙肝表面抗原(HBsAg)阳性孕妇及新生儿血清白细胞介素(IL)-6、IL-17、IL-23水平与乙肝病毒(HBV)宫内感染关系。方法:回顾性收集2021年1月-2023年12月本院就诊的HBsAg阳性孕妇140例的临床资料为HBsAg阳性组,按照新生儿脐带血检测结果分为宫内感染组(n=28)与未感染组(n=112),同期HBsAg阴性孕妇140例为HBsAg阴性组。比较孕妇孕28周时外周血及新生儿脐血血清IL-6、IL-17、IL-23水平。受试者工作特征(ROC)曲线分析HBsAg阳性孕妇血清IL-6、IL-17、IL-23水平判断HBV宫内感染临床价值。结果:宫内感染组孕妇血清IL-6(104.33±24.92 ng/L)、IL-17(282.65±76.71 ng/L)、IL-23(269.52±64.28 ng/L)水平均高于未感染组(70.34±18.61、123.41±43.02、113.75±41.68)ng/L与HBsAg阴性组(68.13±17.18、119.53±37.13、110.32±44.43)ng/L(均P<0.05),未感染组与HBsAg阴性组无差异(P>0.05),各组新生儿脐带血清IL-6、IL-17、IL-23水平无差异(P>0.05)。ROC曲线分析,HBsAg阳性孕妇血清IL-6、IL-17、IL-23评估HBV宫内感染的曲线下面积分别为0.791、0.725、0.745,敏感度及特异度在61.6%~78.6%,有一定临床参考价值。结论:宫内感染孕妇孕28周时血清IL-6、IL-17、IL-23水平升高,3项指标对判断HBsAg阳性孕妇发生HBV宫内感染风险有一定临床指导价值。

Sero-Prevalence of HBV, HCV and HEV among the Egyptian Pregnant Females

Background: Viral hepatitis in pregnant women can be caused by multiple types of hepatitis viruses and can cause a wide range of symptoms and complications, ranging from asymptomatic infection to maternal and fetal deaths. Objective: The aim of this study was to evaluate the sero-prevalence and the associated factors of viral hepatitis B (HBV), viral hepatitis C (HCV) and viral hepatitis E (HEV) among the Egyptian pregnant females. Methods: This cross-sectional study was conducted in the period from January to July 2017 in two selected antenatal clinics;El-shat by maternity university hospital at Alexandria city and El-Behera health insurance antenatal clinic at Damanhur city on 261 apparently healthy gravid women. Eligible women were evaluated by a questionnaire about socio-demographic data and viral serological tests were done at El-shat by maternity University Hospital Laboratory. Results: The overall HBs-Ag sero-prevalence in the pregnant women included in this study was 7 cases (2.7%) and HCV-RNA PCR was 4 cases (1.5%). Of the total study participants, none of them (0%) were anti-HEV IgM positive and 48 cases (18.4%) were anti-HEV IgG positive. According to our results, neither age of the woman, place of residence, past family history of hepatitis virus infection nor having a pet animal had any strong association to be considered as an associated factor for acquiring HEV infection. Conclusion: Although it seems that there are many improvements in the prevalence of different hepatitis viruses in the country, hepatitis viral infections are still high enough to continue their preventive programs and health education, to protect the mothers and their fetuses from the hazardous effects of these serious infections.

慢性HBV感染孕妇产后肝炎活动与治疗管理

慢性HBV感染孕妇产后由于免疫功能和激素水平变化,可出现肝炎活动。加强慢性HBV感染孕妇产后肝功能、HBV血清标志物和HBV DNA的监测与优化抗病毒治疗策略,对于确保产妇延缓疾病进展和母婴的安全性至关重要。本文将针对慢性HBV感染孕妇产后肝炎活动的临床特点、发病机制和预测因素及治疗策略进行阐述,帮助临床医生更好地监测慢性HBV感染孕妇产后肝炎活动及治疗管理。

接受母婴阻断治疗的慢性HBV感染孕妇产后肝炎发作的风险预测模型构建

目的:探讨慢性HBV感染孕妇以母婴阻断为目的抗病毒治疗产后肝炎发作的危险因素并构建风险预测模型。方法:纳入2020年1月至2022年10月在上海市公共卫生临床中心产检及分娩的198例慢性HBV感染孕产妇,随访至产后48周,根据随访结束时患者是否肝炎发作,将患者分为肝炎发作组40例(肝炎发作组)和未发作组158例(对照组)。基于两组患者的一般临床资料和开始抗病毒前血清丙氨酸氨基转移酶(ALT)、乙肝病毒DNA定量(HBV DNA)、乙肝表面抗原(HBsAg)、乙肝e抗原(HBeAg)及乙型肝炎病毒核心相关抗原(HBcrAg)定量水平,分析慢性HBV感染孕妇抗病毒治疗产后肝炎发作的危险因素,并构建风险预测模型。结果:肝炎发作组与对照组开始抗病毒前血清ALT、HBcrAg、HBsAg、HBeAg及HBV DNA水平比较,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,抗病毒前较高的血清HBcrAg、HBsAg、HBeAg及HBV DNA水平是影响慢性HBV感染孕产妇产后肝炎发作的独立危险因素(P<0.05)。这些独立危险因素对产后肝炎发作有良好的预测价值,且四者联合诊断预测价值更高(AUC=0.953)。结论:联合检测开始抗病毒前血清HBcrAg、HBsAg、HBeAg及HBV DNA水平对慢性HBV感染孕产妇产后肝炎活动有良好的预测意义,可为临床随访和决策提供参考。

妊娠期抗病毒治疗阻断HBV母婴传播的新进展

HBV母婴传播是导致我国慢性乙型肝炎疾病高负担的主要原因之一,阻断这一传播途径对消除乙型肝炎具有至关重要的战略意义。新生儿出生立即实施联合免疫接种是阻断HBV母婴传播的基本策略,但在高病毒血症母亲中仍有9%的母婴传播率。近年来,孕期抗病毒干预阻断母婴传播的研究取得了突破,对消除乙型肝炎母婴传播具有划时代意义。孕期抗病毒干预与婴儿出生后联合免疫接种的综合预防,已成为消除乙型肝炎母婴传播的关键策略。本文总结了妊娠期抗病毒干预阻断母婴传播的发展历程和最新进展,并归纳相关干预策略和适应证等,旨在为临床和公共卫生医生提供参考。

富马酸丙酚替诺福韦对HBV感染免疫耐受期孕妇母婴阻断效果及安全性评价

目的研究富马酸丙酚替诺福韦对乙型肝炎病毒(HBV)感染免疫耐受期孕妇的母婴阻断效果及安全性。方法选取2021年1月至2023年1月在海南医学院第二附属医院诊治的28例HBV感染免疫耐受期孕妇,根据抗病毒方案分为富马酸替诺福韦二吡呋酯(TDF)组和富马酸丙酚替诺福韦(TAF)组。对比两组HBV DNA载量、肾小球滤过率(eGFR)、尿β2微球蛋白及不良反应发生率。结果两组治疗后HBV DNA较治疗前下降,P<0.05;两组治疗后eGFR与治疗前对比,P>0.05;治疗后TDF组尿β2微球蛋白较治疗前明显升高,且高于TAF组,P<0.05。两组不良反应发生率对比,P>0.05。两组新生儿HBV DNA、HBsAg和HBeAg检测结果均为阴性。结论对HBV感染免疫耐受期孕妇采用富马酸丙酚替诺福韦治疗的效果显著,可有效降低其HBV DNA载量,获得良好的母婴阻断效果,且对肾脏的安全性良好。

HBeAg阳性妊娠慢性HBV携带者母婴阻断停药后肝炎活动的危险因素研究

目的观察HBeAg阳性妊娠慢性HBV携带者启动以母婴阻断为目的的抗病毒治疗基线至产后96周内HBV RNA、HBV DNA、qHBsAg、qHBeAg、ALT等指标的动态变化,分析产后96周内肝炎活动的危险因素。方法回顾性纳入接受预防性抗病毒治疗并于产后12周内停药、且完成产后96周随访的妊娠HBeAg阳性患者,观察抗病毒治疗基线、妊娠36周、产后停药时和/或产后24周、产后96周HBV RNA、HBV DNA、qHBsAg、qHBeAg以及生化学指标的动态变化。结果共纳入146例中位治疗时间为16.4周的HBeAg阳性妊娠慢性HBV携带者。抗病毒治疗期间HBV DNA水平及qHBeAg逐渐下降,HBV RNA逐渐增高,qHBsAg水平在孕36周时较基线降低,停药时升高超过基线水平。产后24周上述指标均反弹接近或超过基线水平。产后96周随访,共5例患者发生HBeAg血清学转换,无一例发生HBsAg清除。产后停药时与产后24周肝炎活动比例最高(30.1%vs.30.8%),但随访至产后96周,仅14例(9.59%)患者因肝炎活动需抗病毒干预。根据是否再次启动抗病毒治疗将患者分为复发组(n=14)与未复发组(n=132)。10例患者在停药6个月以后复发,中位复发时间13.5月。两组间抗病毒治疗药物类型、基线至孕36周HBeAg降幅的差异具有统计学意义。结论HBeAg阳性妊娠慢性HBV携带者预防性抗病毒治疗期间及停药后均有不同比例肝炎活动,停药时、产后24周达高峰,但仅少数患者需再次抗病毒干预,且与HBV活动相关的肝炎发作多发生在停药6个月以后,应加强停药后的长期规律随访。抗病毒基线至孕36周HBeAg降幅是预测产后停药肝炎活动的独立危险因素。

宁夏地区孕产妇HBV检测及感染状况调查研究

目的 了解2015—2021年宁夏地区孕产妇乙型肝炎病毒(HBV)检测及感染情况。方法 收集2015—2021年宁夏各助产机构发现并上报的感染HBV的孕产妇信息,通过预防艾滋病、梅毒和乙型肝炎母婴传播信息管理系统收集相关数据,并分析宁夏地区孕产妇HBV检测率、检测时期和HBV表面抗原(HBsAg)阳性率及其分布特征。结果 2015—2021年宁夏孕产妇HBV检测率99.95%,孕期检测率从69.11%上升至98.13%。累计648 360例孕产妇接受了HBV检测,报告HBsAg阳性孕产妇24 600例,HBsAg阳性率3.79%。24 600例HBsAg阳性孕产妇中,4 847例(19.70%)为仅产时接受检测。孕产妇孕期HBsAg阳性率呈逐年上升趋势,仅产时HBsAg阳性率呈逐年下降趋势,且2015—2019年孕产妇仅产时HBsAg阳性率均高于同期孕产妇孕期HBsAg阳性率。此外,2021年报告2 435例HBV感染孕产妇感染模式,14~<25岁组以模式1感染为主,25~<35岁组、35~<47岁组均以模式2感染为主。结论 2015—2021年宁夏地区孕产妇HBV检测率保持较高水平,孕期检测率显著上升,但仍存在一定比例的产时检测,需进一步采取措施促进孕产妇孕期尽早接受HBV检测,同时加强HBV感染孕产妇疾病监测管理。

基于信息移动网络的健康管理对HBV感染孕妇服药依从性及HBV母婴传播阻断效果的影响

目的 探讨基于信息移动网络的健康管理在乙型肝炎病毒(HBV)感染孕妇中的应用效果。方法 回顾性纳入惠州市第六人民医院2022年5月至2023年4月收治的HBV感染孕妇72例,按护理方法不同分为两组,各36例。两组均行常规治疗,对照组实施常规健康宣教,观察组实施基于信息移动网络的健康管理,两组均持续观察至孕妇分娩后4周。对比两组服药依从性、HBV理论知识掌握、HBV母婴传播阻断效果及护理满意度。结果 观察组服药依从性高于对照组(94.44%vs. 77.78%,P=0.041);观察组护理后HBV理论知识掌握情况评分为(80.12±7.60)分,高于对照组的(74.60±7.48)分(P=0.003);观察组新生儿HBsAb阳转率高于对照组(88.89%vs. 69.44%,P=0.042),HBsAg阳性率低于对照组(2.78%vs. 22.22%,P=0.033);观察组护理满意度高于对照组(94.44%vs. 77.78%,P=0.041)。结论 基于信息移动网络的健康管理能够提升HBV感染孕妇服药依从性,提升其HBV理论知识掌握水平,获得较好的HBV母婴传播阻断效果,患者护理满意度较高。

乙肝大小三阳状态、不同HBVDNA载量孕妇肝功能指标水平分析

目的研究探讨乙肝孕妇大三阳和小三阳状态中乙型肝炎病毒(Hepatitis B virus,HBV)DNA载量、肝功能指标、肝纤维化标志物含量及不同HBVDNA载量孕妇的肝功能水平。方法选取临清市人民医院于2020年1月—2023年1月收治的120例乙肝孕妇作为研究对象,根据乙肝两对半检测结果将其分为两组,即大三阳组(n=60)和小三阳组(n=60)。比较两组HBVDNA载量、肝功能指标、肝纤维化标志物含量及不同HBVDNA载量孕妇的肝功能指标、肝纤维化标志物含量。结果大三阳组丙氨酸转移酶水平(29.00±7.62)U/L、HBVDNA水平(5.18±1.16)×10^(4)U/mL均高于小三阳组的(26.00±2.85)U/L、(2.08±1.11)×10^(4)U/mL,差异有统计学意义(t=2.856、14.956,P均<0.05)。大三阳组的重组人几丁质酶3样蛋白1水平低于小三阳组,差异有统计学意义(P<0.05)。伴随着HBVDNA载量上升,两组患者甲胎蛋白水平随之增加,但是在同等HBADNA载量下,两组甲胎蛋白水平比较,差异无统计学意义(P>0.05)。结论开展孕前抗乙肝病毒诊疗、孕期风险系数评估,采取科学有效的干预措施,均能够有效抑制乙肝在母婴中的传播。

乙肝孕妇HBV-DNA载量检测在母婴传播筛查中的应用效果评估

目的:分析乙肝孕妇乙型肝炎病毒(hepatitis B virus,HBV)脱氧核糖核酸(Deoxyribonucleic acid,DNA)载量检测在母婴传播筛查中的应用效果评估。方法:选取2021年1月至2022年1月乙肝孕妇100例进入研究,根据孕妇乙肝两对半定性检测结果分为大三阳组,小三阳组和其他组,比较各组间孕妇新生儿脐带血HBV-DNA载量检测结果及1年后新生儿HBV DNA阳性率;比较不同HBV-DNA载量孕妇新生儿脐带血HBV-DNA载量检测结果。结果:100例孕妇中大三阳46例(46.00%),小三阳32例(32.00%),其他22例(22.00%)。100例孕妇中新生儿脐带血HBV-DNA阳性共14例,宫内感染发生率14.00%。大三阳组新生儿脐带血HBV-DNA阳性率显著高于小三阳组和其他组(P<0.05);三组间1年后新生儿HBV DNA阳性率无显著性差异(P>0.05);100例孕妇中HBV-DNA载量≥10^(5)37例(37.00%),10^(3)~10^(5)44例(44.00%)和<10^(3)19例(19.00%)。HBV-DNA载量≥10^(5)中新生儿脐带血HBV-DNA阳性率显著高于10^(3)~10^(5)和<10^(3)(P<0.05);HBV-DNA载量≥10^(5)中平均新生儿脐带血HBV-DNA log病毒载量显著高于10^(3)~10^(5)(P<0.05)。结论:乙肝孕妇HBV-DNA载量检测对母婴传播具有重要意义,该检测有助于评估孕妇感染程度、预测婴儿感染风险,并监测治疗效果,值得推广应用。

HBeAg阳性慢性乙型肝炎孕妇替比夫定治疗前后血清Th1/Th2型细胞因子的水平变化

目的通过观察慢性HBV感染孕妇替比夫定治疗前后血清Th1/Th2型细胞因子水平变化,探讨替比夫定阻断HBV母婴传播的免疫机制。方法对2008年4月至2012年9月收治的HBeAg阳性慢性HBV感染孕妇54例进行回顾分析,根据ALT水平分为免疫活化组(n=18)和免疫耐受组(n=36),于妊娠中晚期给予替比夫定600 mg/d,常规检测治疗前、分娩前血清ALT、TBil、HBV DNA水平及HBV标志物变化情况,酶联免疫吸附测定法检测Th1型细胞因子[白细胞介素(IL)2、干扰素(IFN)γ]和Th2型细胞因子(IL-4、IL-6)水平。正态分布的计量资料采用t检验,非正态分布的采用非参数检验。以Bivariate分析两变量相关性,用Pearson相关系数表示相关性。结果替比夫定治疗后血清HBV DNA水平明显下降(P<0.01),ALT、TBil水平均无显著变化,无HBeAg血清学转换。相较于健康人群,2组在治疗前和分娩前均表现为IL-2(健康人群<4 pg/ml)和IFNγ(健康人群<15 pg/ml)高表达,而IL-4(健康人群<10 pg/ml)和IL-6(健康人群<5 pg/ml)低表达。治疗前和分娩前的IL-2、IFNγ、IL-4和IL-6水平在2组之间差异均无统计学意义(P>0.01)。分娩前较治疗前,免疫活化组IL-4水平有升高(P=0.014),但均未超出正常上限;IL-2、IFNγ和IL-6水平无显著变化(P=0.182、0.259、0.710);免疫耐受组IL-2、IFNγ、IL-4和IL-6水平均无显著变化(P=0.651、0.839、0.650、0.542)。结论 HBV感染孕妇妊娠中晚期血清Th1型细胞因子高表达、Th2型细胞因子低表达;替比夫定短期治疗对孕妇Th1/Th2平衡影响较小,其参与阻断HBV母婴传播可能通过其他途径发挥作用。