HBsAg阳性的1355名孕妇乙型肝炎病毒母婴传播的随访调查  

Follow-up study on hepatitis B virus mother-to-child transmission in 1355 HBsAg-positive pregnant women

作　　者：周瑾[1] 尹玉竹[1] 吴玲玲[1] 张培珍[1] 李小毛[1] 

机构地区：[1]中山大学附属第三医院妇产科,广州510630

出　　处：《中华传染病杂志》2012年第6期343-348,共6页Chinese Journal of Infectious Diseases

基　　金：广东省自然科学基金资助项目（05001670）;广东省科技计划项目（20088060600023）

摘　　要：目的观察HBsAg阳性孕妇所分娩婴儿的HBV感染情况。方法前瞻性收集血清HBsAg阳性孕妇1355名及其所分娩的新生儿1360名（包括5名双胎）的资料，所有新生儿均于出生6h内注射乙型肝炎免疫球蛋白200U，并按0-1-6方案接种重组酵母乙型肝炎疫苗10μg，随访新生儿至12月龄，检测0、7、12月龄婴儿外周血HBV血清学标志物和HBVDNA定量。定量资料采用t检验，定性资料采用卡方检验、秩和检验或Fisher确切概率法。结果1360名婴儿随访至12月龄时，21名发生HBV感染，总的宫内感染率为1．54％。其中母亲为HBeAg阳性者的宫内感染率为4．44％，HBeAg阴性者未发生宫内感染（X^2=5．99，P〈0．05）；母亲为HBVDNA阳性者的宫内感染率为3．13％，阴性者也未发生宫内感染（X^2=21．84，P〈0．05）。母亲血清HBVDNA≥1×10^7IU／mL者的宫内感染率为6．01％，较HBVDNA〈1×10^7 IU／mL者明显升高（X^2=39．43，P〈0．05）。结论新生儿经严格的主一被动联合免疫后，仍存在HBV的宫内感染。其中母亲为HBeAg阳性者及HBVDNA高复制水平者的宫内感染率明显增高；宫内感染是导致HBV母婴传播免疫阻断失败的主要原因。Objective To investigate hepatitis B virus （HBV） mother-to-child transmission rate in hepatitis B virus surface antigen （HBsAg）-positive pregnant women. Methods A total of 1355 HBsAg-positive pregnant women and their 1360 newborns （included 5 twins） were collected prospectively. All newborns received hepatitis B immunoglobulin （HBIG） 200 U intramuscularly within 6 hours of birth as early as possible, and were administered with routine 10 μg recombinant hepatitis B vaccine （at 0, 1, 6 months of birth）. The venous blood HBV markers and HBV DNA levels were detected in all newborns at 0, 7, 12 months of age. The measurement data were analyzed by t test. Qualitative data were analyzed by chi square test, rank sum test or Fisher exact test. Results The intrauterine HBV infection rate of 1360 infants were 1.54% （21/1360） during 12 months of follow-up. The rate of intrauterine infection in HBeAg positive mothers was significant higher than that of HBeAg negative mothers （4. 44% vs 0, X^2=35.99; P〈0, 05）; the rate of intrauterine infection in HBV DNA positive mothers was significant higher than that of HBV DNA negativemothers （3.13% vs0, X^2=21.84; P〈0.05）. When maternal serum HBV DNA≥1×10^7 IU/mL, the rate of intrauterine infection was 6. 01G, which was significantly higher than that of maternal serum HBV DNA% 1 × 10^7 IU/mL （X^2 = 39. 43, P 〈 0. 05）. Conclusions After strict combined active-passive immunization, the rate of HBV intrauterine infection is 1. 54%. When mothers are HBeAg positive or with high level of HBV DNA, the rate of HBV intrauterine infection increases significantly. Intrauterine infection is the main cause of failure in immunoblockade of HBV mother-to- child transmission.

关 键 词：肝炎病毒 乙型 肝炎表面抗原 疾病传播 垂直 胎儿疾病 免疫球蛋白类 接种 

分 类 号：R714[医药卫生—妇产科学]