乙型肝炎病毒母婴传播易患因素分析  

Analysis on risk factors of mother- to- fetus transmission of hepatitis B virus

作　　者：温坚 冯薇 陈洁[2] 陈廷美 胡娅莉[2] 周乙华[2] 徐陈瑜 

机构地区：[1]江苏省镇江市妇幼保健院妇产科,212001 [2]南京大学医学院附属鼓楼医院

出　　处：《中国妇幼保健》2014年第31期5063-5065,共3页Maternal and Child Health Care of China

基　　金：国家临床重点专科建设项目〔2011271〕;江苏省母胎医学重点学科建设项目〔XK201102〕;镇江市科技计划项目〔F22012047〕

摘　　要：目的:探讨乙型肝炎病毒(HBV)携带母亲的新生儿母婴感染的易患因素。方法:回顾性分析HBs Ag阳性孕妇及其子女,结合住院病历及随访调查,记录母亲分娩方式、哺乳方式、儿童疫苗接种等资料,并对母亲和子女采血检测HBV血清学标志。结果:250例随访儿童中,238例出生24 h内接种了第1针乙肝疫苗,179例24 h内注射了乙肝免疫球蛋白(HBIG);儿童HBs Ag阳性4例,阳性率1.6%。其中HBe Ag阳性母亲48例的子女HBs Ag阳性4例,阳性率为8.3%明显高于孕期HBe Ag阴性母亲的子女HBs Ag阳性率为0.0%(P<0.01)。经剖宫产和阴道分娩的子女HBs Ag阳性率分别为2.1%(3/140)和0.9%(1/110)(P>0.05),人工喂养儿童HBs Ag阳性率4.8%(4/83)高于母乳喂养(P<0.05),可能与人工喂养组母亲HBe Ag阳性率53.0%(44/83)明显高于母乳喂养组2.4%(4/167)有关(P<0.01)。结论:母亲HBe Ag阳性是发生HBV母婴传播的危险因素,新生儿正规免疫预防后剖宫产和人工喂养并不降低HBV母婴感染的风险。因此,不能将剖宫产分娩作为减少HBV母婴传播的手段,并应该鼓励HBs Ag阳性产妇进行母乳喂养。[Abstract ] Objective： To explore the risk factors of mother - to - fetus transmission of hepatitis B virus （HBV） in infants born by mothers carrying HBV. Methods： The pregnant women with positive HBsAg and their infants were analyzed retrospectively by medical re- cord review and follow- up investigation; maternal delivery modes, feeding patterns and vaccination situations were recorded; maternal and infantile blood samples were obtained to detect HBV serological markers. Results： Among 250 infants followed up, 238 infants underwent HBV vaccination for the first time within 24 hours after birth, 179 infants underwent hepatitis B immunoglobulin （HBIG） injection within 24 hours after birth; 4 infants were found with positive HBsAg, the positive rate was 1.6%. A total of 48 mothers were found with positive HB- sag, and 4 infants were found with positive HBsAg, the positive rate was 8.3%, which was statistically significantly higher than that of in- fants born by mothers with negative HBeAg （0. 0% ） （P 〈 0.01 ） . The positive rates of HBsAg in infants born by cesarean section and vagi- nal delivery were 2. 1% （3/140） and 0. 9% （ 1/110）, respectively, there was no statistically significant difference （P 〉0. 05） ; the posi- tive rate of HBsAg in breast- fed infants was 4. 8% （4/83）, which was statistically significantly higher than that in formula -fed infants （ P 〈 0. 05 ）, which might be correlated with that the positive rate of HBeAg in mothers taking artificial feeding [ 53.0% （44/83） ]was sta- tistically significantly higher than that in mothers taking breast feeding ~ 2. 4% （4/167） ~ （P 〈 0. 01 ） . Conclusion： Maternal positive HBeAg is a risk factor for mother - to - fetus transmission of HBV. After regular normal immune prevention, cesarean section and artificial feeding cant reduce the risk of maternal and infantile HBV infection. Therefore, cesarean section can not be used as a method to reduce HBV mother- to- fetus transmission, breast feeding

关 键 词：乙型肝炎病毒 母婴传播 分娩方式 喂养方式 

分 类 号：R514.62[医药卫生—内科学]