影响阻断乙型肝炎病毒母婴传播的危险因素分析  

Identification of risk factors related to the failure of immunization to interrupt hepatitis B virus perinataltransmission

作　　者：尹玉竹[1] 周瑾[1] 张培珍[1] 侯红瑛[1] 

机构地区：[1]中山大学附属第三医院妇产科,中山510630

出　　处：《中华肝脏病杂志》2013年第2期105-110,共6页Chinese Journal of Hepatology

基　　金：广东省自然科学基金（05001670）;广东省科技计划项目（2008B060600023）

摘　　要：目的探讨影响阻断HBV母婴传播的危险因素。方法前瞻陛收集血清HBsAg阳性孕妇1355例及其新生儿1360名（双胞胎5对）的资料，所有新生儿于出生24h内尽早进行主一被动联合免疫，并随访至12月龄。于0、7、12月龄采集婴儿外周静脉血检测HBV血清标志物及HBVDNA水平。根据是否发生母婴传播分成感染组和非感染组，分析影响阻断HBV母婴传播的危险因素。计量资料采用t检验；计数资料采用x^2检验、秩和检验或Fisher确切概率法；多因素分析采用非条件logistic回归分析。结果1360名新生儿随访至12月龄时，发生HBV感染2l例，未感染1339例，母婴传播率为1．54％。其中母亲为孕期注射乙型肝炎免疫球蛋白者与未注射者的感染率（2．2揣与1．11％）、剖宫产和阴道分娩者的感染率（1．73％与1．35％）相比，差异均无统计学意义（P〉0．05）；而母亲为HBeAg阳性者的感染率较阴性者明显升高（4．44%与0）；母亲为HBVDNA阳性者的感染率较阴性者明显升高（3．13％与0）；母亲血清HBVDNA≥1．0×10^-7 IU／ml者的感染率较1．0×10^-7～1．0×10^-6 IU／ml者及〈1．0×10^-3 IU／ml者明显升高（分别为6．01％，0．56％，0），差异均有统计学意义（P〈0．05）。多因素logistic回归分析显示孕妇血清HBeAg阳性和HBVDNA≥1．0x10^-7 IU／ml是发生HBV母婴传播的两个独立危险因素，相对危险度分别为31．74（95％可信区间为3．88～259．38）和22．58（95％可信区间为4．75～107．40）。结论新生儿经严格的主一被动联合免疫后，影响阻断HBV母婴传播的两个独立危险因素为孕妇血清HBeAg阳性和HBVDNA≥1．0×10^-7 IU／ml。Objective To explore the factors influencing failure of an immunization to interrupt perinatal （mother-to-child） transmission of hepatitis B virus （HBV）. Methods Between June 2006 and March 2010, a total of 1355 pregnant women testing positive for the hepatitis B surface antigen （HBsAg）, at gestational weeks 20 N 42, and without use of antiviral or immunomodulatory drugs during the pregnancy were prospectively recruited to the study. The mothers were given a choice of receiving hepatitis B immunoglobulin （HBIG; three 200 IU intramuscular injections give at four-week intervals starting from gestation week 28） or not. All neonates （1360, including five sets of twins） received hepatitis B vaccine （10 μg） plus HBIG （200 IU） combined immunization within 24 h of birth, as early as possible. Peripheral venous blood samples were collected from the neonates within 24 h of birth and at 7 and 12 months of age for detection of HBV markers, including hepatitis B e antigen （HBeAg） and HBV DNA. The infants were classified according to HBV perinatal transmission status （infection group and non-infection group） and various factors （maternal-related： ane. maviditv, varitv： Dremmncv/birth-related： threatened premature labor, complications; neonate-related： sex,birth weight, apgar score） were compared between the two groups by using non-conditional logistic regression analysis to determine their potential influence on failure of immunization to inhibit lransmission. Results After 12 months of follow-up, 1.54% （21/1360） of the neonates had presented with HBV infection. Analysis of the HBV- infected neonates revealed differences in infection rates between neonates born to mothers with HBIG injection （2.22% vs. without HBIG injection： 1.11%,P 〈 0.05） and caesarean section （1.35% vs. vaginal delivery： 1.73%） but neither reached statistical significance （P 〉 0.05）; only the practice of breastfeeding showed a significant difference for infection rate, with neonates f

关 键 词：肝炎病毒 乙型 疾病传播 垂直 联合免疫 影响因素 

分 类 号：R512.62[医药卫生—内科学]