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.

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

AIM To determine the seroprevalence of hepatitis B surface antigen(HBsAg) among pregnant women attending antenatal clinic in Honiara, Solomon Islands. METHODS This 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. RESULTS The 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. CONCLUSION Hepatitis B is a disease of public health importance in Solomon Islands and emphasize the need for integrated preventative interventions for its control.

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。

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。

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 HBsAg 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).

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。

孕晚期孕妇B族链球菌感染对母婴结局的影响

目的:分析孕晚期孕妇B族链球菌(GBS)感染对母婴结局的影响。方法:选取2023年1—6月于该院进行产检的4415名孕晚期孕妇进行前瞻性研究,均行GBS检测,根据是否感染GBS将其分为GBS阳性组与GBS阴性组,统计不同年龄段孕晚期孕妇GBS感染情况及GBS阳性孕晚期孕妇的药敏试验结果,并比较两组不良母婴结局发生率。结果:4415名孕晚期孕妇中,GBS阳性244名,GBS感染率为5.53%(244/4415);>35岁孕晚期孕妇GBS阳性率高于≤35岁孕晚期孕妇,差异有统计学意义(P<0.05);244名GBS阳性孕晚期孕妇对氨苄西林、万古霉素、青霉素、头孢曲松的敏感率均为100.00%,对红霉素、克林霉素、阿奇霉素、左氧氟沙星的耐药率分别为66.80%、62.30%、59.84%、56.97%,耐药率均较高;GBS阳性组胎膜早破、早产、产后出血、产褥感染、胎儿宫内窘迫、新生儿肺炎、新生儿窒息等不良母婴结局发生率均高于GBS阴性组,差异有统计学意义(P<0.05)。结论:孕晚期孕妇GBS感染可提高不良母婴结局发生率。

HBV感染孕产妇宫内感染发生情况及与病毒载量关系

目的:探究乙型肝炎病毒(HBV)感染不同类型、HBV-DNA病毒载量孕产妇宫内感染发生情况,分析不同HBV-DNA病毒载量与细胞因子水平相关性。方法:选取本院2020年1月-2023年10月产前检查并足月分娩的乙型肝炎病毒表面抗原(HBsAg)阳性孕妇100例及其新生儿,统计新生儿HBV宫内感染情况,检测产妇HBV-DNA病毒载量水平,对比不同乙肝感染类型、HBV-DNA病毒载量孕产妇宫内感染发生率,不同HBV-DNA病毒载量孕产妇白介素-6(IL-6)、干扰素γ(IFN-γ)水平差异,Spearman相关系数分析HBV-DNA病毒载量与IL-6、IFN-γ的相关性。结果:100例孕产妇中HBsAg+HBeAg+HBcAb感染36例(36.0%)、HBsAg+HBeAb+HBcAb感染64例(64.0%);宫内感染发生率为25.0%,宫内感染发生率HBsAg+HBeAg+HBcAb孕产妇(22.2%)高于HBsAg+HBeAb+HBcAb孕产妇(3.1%)(P<0.05);HBV-DNA病毒载量阴性6例,10^(3)~10^(5)病毒载量62例、>105病毒载量32例,10^(3)~10^(5)病毒载量孕妇宫内感染发生率(4.8%)低于>10^(5)病毒载量孕妇(21.9%),IL-6水平(8.11±0.89pg/ml)低于>10^(5)病毒载量孕产妇(11.26±1.56pg/ml)且与HBV-DNA载量呈正相关,IFN-γ水平(68.47±7.10pg/L)高于>105病毒载量孕产妇(51.22±5.65pg/L)且与HBV-DNA载量呈负相关(均P<0.05)。结论:感染HBV孕产妇宫内感染发生风险升高,主要感染类型是HBsAg+HBeAb+HBcAb,但HBsAg+HBeAg+HBcAb型、HBV-DNA病毒载量高孕产妇宫内感染风险提高,HBV-DNA病毒载量增加宫内感染风险可能与调控Th1/Th2免疫失衡有关。

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。

HBV携带孕妇妊娠期及产后肝炎发作风险及NAs干预观察

目的研究慢性乙型肝炎病毒(HBV)携带孕妇妊娠期及产后肝炎发作风险及核苷(酸)类似物(NAs)干预的价值。方法纳入2020年1月至2022年1月南宁市第四人民医院300例HBV携带孕妇,入院后依据患者治疗意愿分为观察组232例,对照组68例。于妊娠6周检查壳多糖酶3样蛋白1(CHI3L1),并于不同时点检测ALT、HBV DNA及HBeAg。对照组仅接受保肝治疗,观察组若肝炎发作或CHI3L1>79 ng/mL则长期口服替诺福韦,300 mg/d,1次/d;若无肝炎症状则自妊娠第24周开始口服替诺福韦,300 mg/d,1次/d,分娩后停药。比较两组患者各时点ALT水平、HBV DNA阴转率、HBeAg阴转率、肝炎发作率。结果观察组患者妊娠6周时HBV DNA阴转、HBeAg阴转为8例(3.45%)和0、妊娠12周时为61例(26.29%)和9例(3.88%)、妊娠24周时为102例(43.97%)和13例(5.60%)、妊娠36周时为163例(70.26%)和18例(7.76%),且妊娠36周时各项指标均优于其他时点(P<0.05);对照组患者各指标妊娠6周时为4.41%和0、妊娠12周时为8.82%和4.41%、妊娠24周时为11.76%和7.35%、妊娠36周时为13.24%和8.82%,差异无统计学意义(P>0.05)。观察组妊娠期及产后肝炎总发作率为21.55%(50/232),低于对照组的73.53%(50/68),差异有统计学意义(P<0.05)。结论无论有无NAs干预,HBV携带孕妇妊娠期及产后均有肝炎发作,且产后6周发作率较高,同时于妊娠期及产后行个体化NAs干预可有效降低肝炎总发作率。

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.

Prevention of Mother-to-Child Transmission of Hepatitis B in the Urban District Health Baskuy Burkina Faso

Few studies have been conducted on the epidemiology in pregnancy in sub-Saharan Africa. This study aimed to improve the care of pregnant women infected with hepatitis B virus (VHB) and their newborns in the urban district health. Method: This study was conducted from 01/09/2014 to 01/09/2015. Study involved three types of data collection: a collection of data from health facilities involved in the project;repeated cross-sectional survey among health personnel;a pros- pective study of pregnant women identified positive for HBsAg and followed at the University Hospital Yalgado Ouédraogo (CHU-YO). Knowledge assessment was made among health staff and pregnant women using a knowledge score. Construction of the score came after a factorial analysis of multiple correspondences on population health workers surveyed in the first round (N = 119) on one hand and all pregnant women (N = 266) on the other hand. This had identified among the 79/19 questions, those that discriminated best knowledge of paramedics and pregnant women. For pregnant women, this score was then dichotomized from the center and logistic regression was performed to determine the sociodemographic, medical and obstetric characteristics that influenced it (p value < 005). Results: Health staff had been surveyed twice (N = 119/100). In general, the level of knowledge was good on targeted knowledge, both before and after training. No health worker routinely offered screening for hepatitis B among pregnant women attending antenatal clinics. Altogether 266 pregnant women HBsAg-positive were referred and followed CHU-YO. Half of the patients had a score lower than 2/17. Univariate analysis showed that variables such as education level influenced significantly the level of knowledge. Women with higher levels of education had a higher level of knowledge about the disease, compared to those of primary level [OR = 1.63;[1.34 to 1.99], p value < 0,001]. Newborns during the study period numbered 128 and the vaccine was made in the first 24 hours of life for 83.6% of them. Conclusion: routine screening for infection with VHB during pregnancy and improved knowledge of mothers is strongly reco- mmended in Burkina Faso.

基于血清ADMA、IL-18、PIGF、PCT水平构建B型链球菌感染孕妇不良妊娠结局的风险预测模型

目的分析基于血清非对称性二甲基精氨酸(ADMA)、白细胞介素-18(IL-18)、胎盘生长因子(PIGF)、降钙素原(PCT)水平构建B型链球菌(GBS)感染孕妇不良妊娠结局的风险预测模型,对GBS感染孕妇不良妊娠结局的预测价值。方法选取2021年5月—2022年5月80例GBS感染孕妇作为研究组,同期未发生GBS感染的健康孕妇作为对照组,比较2组血清ADMA、IL-18、PIGF、PCT水平。另对研究组孕妇随访至分娩,根据妊娠结局分为良好组与不良组,采用单因素、多因素Logistic回归分析探讨血清ADMA、IL-18、PIGF、PCT水平与GBS感染孕妇不良妊娠结局的关系。并采用受试者工作特征(ROC)曲线分析基于血清ADMA、IL-18、PIGF、PCT水平构建的风险预测模型对GBS感染孕妇不良妊娠结局的预测效能。结果研究组血清ADMA、IL-18、PCT水平显著高于对照组,血清PIGF水平显著低于对照组(P<0.01)。多因素Logistic回归分析结果显示,ADMA(高)、IL-18(高)、PCT(高)、PIGF(低)、IgA(低)、IgM(低)、IgG(低)、合并糖尿病、合并高血压是GBS感染孕妇发生不良妊娠结局的危险因素(P<0.05,P<0.01)。基于血清ADMA、IL-18、PIGF、PCT水平构建的风险预测模型预测GBS感染孕妇不良妊娠结局的敏感度、准确度、阳性预测值、曲线下面积分别为93.67%、91.12%、90.38%、0.933。结论基于血清ADMA、IL-18、PIGF、PCT水平构建的GBS感染孕妇不良妊娠结局风险预测模型,可较为准确地预测GBS感染孕妇的妊娠结局。

锡林郭勒盟地区妊娠晚期孕妇B族链球菌感染情况分析

目的分析锡林郭勒盟地区妊娠晚期孕妇B族链球菌(GBS)感染率,指导临床预防性用药,减少围生期孕妇及新生儿疾病的发生,提高人口健康水平。方法1123例产科自愿接受检查的妊娠晚期孕妇作为研究对象,在孕35~37周对孕妇阴道分泌物进行采样并检测。分析锡林郭勒盟地区与全国其他地区妊娠晚期孕妇B族链球菌感染率。比较锡林郭勒盟地区汉族与蒙古族妊娠晚期孕妇B族链球菌感染率。结果锡林郭勒盟地区妊娠晚期孕妇B族链球菌感染率为2.76%(31/1123),全国其他地区妊娠晚期孕妇B族链球菌感染率为5%~15%。锡林郭勒盟地区妊娠晚期孕妇B族链球菌感染率在正常范围内,感染率相对较低。锡林郭勒盟地区汉族妊娠晚期孕妇B族链球菌感染率为2.81%,蒙古族妊娠晚期孕妇B族链球菌感染率为2.51%。两个民族妊娠晚期孕妇B族链球菌感染率比较,差异无统计学意义(P>0.05)。结论锡林郭勒盟地区妊娠晚期孕妇B族链球菌感染率居于正常水平,蒙古族与汉族孕妇感染率无差异。

HBV感染孕妇停药后HBV再激活的影响因素

目的:探讨乙型肝炎病毒(HBV)感染孕妇停药后HBV再激活的影响因素。方法:回顾性分析2015年1月至2019年1月新乡市传染病医院收治的129例HBV感染孕妇的临床资料。统计孕妇停药后HBV再激活的占比,采用单因素和多因素Logistic回归分析HBV感染孕妇停药后HBV再激活的影响因素。结果:129例HBV感染孕妇停药后发生HBV再激活56例,占43.41%(56/129);再激活者停药时共价闭合环状DNA(cccDNA)阳性率和乙型肝炎表面抗原(HBsAg)水平均高于未再激活者,差异有统计学意义(P<0.05);再激活者的年龄、体质量指数、饮酒史、HBV感染家族史、治疗药物、病毒学应答时间和丙氨酸氨基转移酶、天冬氨酸氨基转移酶、总胆红素水平与未再激活者比较,差异均无统计学意义(P>0.05);Logistic回归分析结果显示,cccDNA阳性、停药时HBsAg>200 mIU/mL均为影响HBV感染孕妇停药后HBV再激活的危险因素(OR>1,P<0.05)。结论:cccDNA阳性、停药时HBsAg>200 mIU/mL为影响HBV感染孕妇停药后HBV再激活的危险因素。

HBV感染对自然妊娠孕妇孕期并发症及新生儿的影响

目的:观察乙型肝炎病毒(Hepatitis B virus,HBV)感染对自然妊娠孕妇孕期并发症及新生儿的影响。方法:回顾性选取2022年1月至2023年6月于我院产科接受定期产检及分娩的75例自然妊娠孕妇合并HBV感染的临床资料,根据肝功能(血清丙氨酸氨基转移酶(Alanine aminotransferase,ALT)水平)分为异常组(ALT>40 U·L^(-1))36例及正常组(ALT≤40 U·L^(-1))39例,并选择同期正常孕妇37例为对照组。比较三组孕妇孕期、产时及产后并发症和新生儿不良结局。结果:自然妊娠合并HBV感染孕产妇中,肝功能异常39例。异常组孕妇孕期间妊娠期高血压(Pregnancy hypertension,PIH)、肝内胆汁淤积症(Intrahepatic cholestasis,ICP)、妊娠期糖尿病(Gestational diabetes mellitus,GDM)并发症率>正常组>对照组,比较有显著差异(P<0.05)。异常组孕妇产时及产后并发症有胎膜早破、宫内感染、宫内窘迫以及产后大出血,发生率异常组>正常组>对照组(P<0.05)。新生儿不良结局如早产儿、新生儿窒息、死胎以及低体质量儿发生率>正常组>对照组(P<0.05)。结论:HBV感染可影响自然妊娠孕妇肝功能,且孕妇HBV感染肝功能异常者可引起孕妇孕期PIH、ICP、GDM并发症,孕妇产时及产后胎膜早破、宫内感染、宫内窘迫以及产后大出血等并发症发生率和早产儿、新生儿窒息、死亡以及低体质量儿不良围产结局,对母婴损害较大,应在孕期加强肝功能监测,积极进行预防治疗。

妊娠合并感染性疾病孕妇的心理状态影响因素及心理干预效果研究

目的研究妊娠合并感染性疾病孕妇的心理状态及心理干预效果。方法200例产科门诊定期产检的孕妇,其中慢性乙型肝炎病毒感染孕妇103例,梅毒感染孕妇70例,正常孕妇27例。对慢性乙型肝炎病毒感染孕妇和梅毒感染孕妇予以心理干预,正常孕妇予以常规产检。收集比较慢性乙型肝炎病毒、梅毒感染孕妇及正常孕妇的临床特征(年龄、文化程度、孕周、产妇类型);比较慢性乙型肝炎病毒、梅毒感染孕妇及正常孕妇心理状态;比较慢性乙型肝炎病毒感染孕妇及梅毒感染孕妇干预后不同孕期的心理状态;分析妊娠合并感染性疾病孕妇焦虑、抑郁心理状态的影响因素。结果慢性乙型肝炎病毒、梅毒感染孕妇及正常孕妇年龄、文化程度、孕周、产妇类型比较,均无差异(P>0.05)。慢性乙型肝炎病毒感染孕妇、梅毒感染孕妇与正常孕妇的焦虑自评量表(SAS)、抑郁自评量表(SDS)标准分比较有差异(P<0.05);经LSD两两比较,梅毒感染孕妇SAS、SDS标准分分别为(48.56±9.42)、(49.35±9.79)分,均高于慢性乙型肝炎病毒感染孕妇的(44.74±9.98)、(45.19±9.86)分和正常孕妇的(31.48±3.86)、(31.74±3.02)分,有差异(P<0.05);慢性乙型肝炎病毒感染孕妇SAS、SDS标准分高于正常组,有差异(P<0.05)。干预后,慢性乙型肝炎病毒感染孕妇早期、中期、晚期SAS、SDS标准分有差异(P<0.05);经LSD两两比较,早期和中期孕妇SAS、SDS标准分均高于晚期,有差异(P<0.05);早期孕妇SAS、SDS标准分与中期无差异(P>0.05)。干预后,梅毒感染孕妇早期、中期、晚期SAS、SDS标准分有差异(P<0.05);经LSD两两比较,早期和中期SAS、SDS标准分均高于晚期,有差异(P<0.05);早期和中期孕妇SAS、SDS标准分无差异(P>0.05)。Logistic回归分析结果显示,年龄、文化程度、孕周、产妇类型、诊断均为妊娠合并感染性疾病孕妇焦虑、抑郁的独立影响因素(P<0.05)。结论年龄、文化程度、孕周、产妇类型、诊断均为妊娠合并感染性疾病孕妇焦虑、抑郁的独立影响因素,对孕妇实施心理干预有助于改善其不良心理状态,降低焦虑及抑郁评分。

2018-2022年北京市密云区医院孕产妇人类免疫缺陷病毒、梅毒螺旋体、乙型肝炎病毒检测结果分析

目的:分析2018-2022年北京市密云区医院孕产妇人类免疫缺陷病毒(HIV)、梅毒螺旋体、乙型肝炎病毒(HBV)检测结果。方法:选取2018年1月-2022年12月于密云区医院进行孕产期保健及分娩的孕产妇19 327例作为研究对象,收集并分析孕产妇一般资料及HIV、梅毒螺旋体和HBV初筛结果。结果:19 327例孕产妇中,HIV阳性0例,梅毒螺旋体阳性101例(0.52%),HBV阳性175例(0.91%)。2018-2022年梅毒螺旋体和HBV阳性呈小幅度波动,其中以2021年明显降低。孕产妇梅毒螺旋体、HBV阳性率及构成比均以20~29岁最高,40~45岁最低。结论:2018-2022年北京市密云区医院孕产妇HIV、梅毒螺旋体、HBV阳性率较低,以20~29岁最多,临床应针对此情况采取应对措施,消除艾滋病、梅毒、乙型肝炎的母婴传播。

Gender development and hepatitis B and C infections among pregnant women in Africa:a systematic review and metaanalysis

Background:Although Africa is a region of hyper endemicity to viral hepatitis B(HBV)and C(HCV)infections,there is limited data on their related burden among pregnant women.The present systematic review and meta-analysis aimed to determine the magnitude of these infections among pregnant women living in Africa and investigate its association with gender-related human development indicators.Main text:We searched PubMed,Embase,Web of Science,Africa Journal Online,and Global Index Medicus,with no language restriction,to identify observational studies on HBV and HCV infections in pregnant women residing in Africa published from January 1,2000 until December 31;2017.Eligible studies reported the prevalence of HBV and/or HCV infection(s)(HBs antigen and HCV antibodies)and/or infectivity(HBe antigen or detectable HCV viral load).Each study was independently reviewed for methodological quality.We used a random-effects model metaanalysis to pool studies.In total,145 studies(258251 participants,30 countries)were included,of which 120(82.8%)had a low,24(16.5%)a moderate,and one(0.7%)had a high risk of bias.The prevalence of HBV and HG/infections was 6.8%(95%confidence interval[CI]:6.1-7.6,113 studies)and 3.4%(95%CI:2.6-A.2,58 studies),respectively.The prevalence of HBe antigen and HCV detectable viral load was 18.9%(95%CI:14.4-23.9)and 62.3%(95%CI:51.6-72.5)in HBV positive and HCV positive pregnant women,respectively.The multivariable meta-regression analysis showed that the prevalence of HBV infection increased with decreasing gender development index,males,level of education and females'expected years of schooling.Furthermore,this prevalence was higher in rural areas and in western and central Africa.The prevalence of HCV infection increased with decreasing proportion of seats held by women in parliament.Conclusions:To address the burden of HBV and HCV infections,beyond well-known risk factors at the individual-level,macro-level factors including gender-related human development indicators and dwelling in rural areas should be considered.In Africa,HBV or HCV infeaed mothers seems to have high potential of transmission to their children.