HBsAg阳性母亲HBeAg状态和分娩方式对HBV宫内传播的影响及交互作用  

Effects related to HBeAg status and mode of delivery as well as the interactions on intrauterine transmission among HBsAg-positive mothers

作　　者：温海秀 张芳[1] 王婷[1] 王斌[1] 王雪飞[1] 许喜喜 付振东[1] 郭健[1] 张临瑞[1] 高怡[2] 汪波[3] 王素萍[1] 

机构地区：[1]山西医科大学流行病学教研室,太原030001 [2]山西医科大学毒理学教研室,太原030001 [3]太原市第三人民医院妇产科,030001

出　　处：《中华流行病学杂志》2016年第6期791-795,共5页Chinese Journal of Epidemiology

基　　金：国家自然科学基金（81072341）

摘　　要：目的了解HBsAg阳性母亲HBeAg状态与分娩方式对新生儿HBV宫内传播的影响及交互作用。方法采用病例对照研究的方法，选择2011年7月至2013年1月在太原市第三人民医院妇产科分娩的344对HBsAg阳性孕妇及其新生儿，收集其一般人口学特征及分娩情况等资料，采用电化学发光法（ECLIA）和荧光定量聚合酶链反应（FQ—PCR）分别检测母亲及新生儿血清HBV标志物与HBVDNA，根据新生儿是否有HBV宫内传播分为病例组（42例）和对照组（302例）。采用单因素，检验和非条件logistic回归分析，探讨母亲HBeAg状态和分娩方式对HBV宫内传播的影响及交互作用。结果344例HBsAg阳性母亲新生儿HBV宫内传播率为12．21％（42／344），母亲HBeAg阳性和阴性两组新生儿HBV宫内传播率分别为18．52％（30／162）和6．59％（12／182），阴道产和剖宫产两组新生儿HBV宫内传播率分别为22．22％（34／153）和4．19％（8／191）。非条件logistic回归分析显示，HBeAg阳性母亲所生新生儿发生HBV宫内传播的风险是HBeAg阴性母亲所生新生儿的3．003倍（OR=3．003，95％CI：1．368～6．593），分娩方式为阴道产时新生儿发生HBV宫内传播的风险是剖宫产的7．333倍（OR=7．333，95％CI：3．108—17．302）。母亲HBeAg状态和分娩方式存在相加交互作用，其超额相对危险度（RERI）、交互作用归因比（AP）和交互作用指数（SI）分另0为14．229（95％CI：-8．479—36．938）、0．587（95％CI：0．271～0．903）和2．579（95％CI：1．100～6．047），但不存在相乘交互作用（OR=1．084，95％CI：0．720～1．632）。结论母亲HBeAg阳性和阴道产可能是新生儿HBV宫内传播的危险因素，母亲HBeAg状态与分娩方式存在相加交互作用。建议HBeAg阳性母亲行剖宫产的方式结束分娩。Objective To investigate the relationship between HBeAg status, mode of delivery and intrauterine transmission of the HBsAg-positive mothers as well as their interactions. Methods A total of 344 HBsAg-positive pregnant women and their infants were enrolled in this study. The mothers were recruited from the Third People＇s Hospital of Taiyuan, from July 2011 to January 2013. Serum HBV-M and HBV DNA were measured using the electro-chemiluminescence immune-assay （ECLIA） kits and fluorescene quantitative polymerase chain reaction （FQ-PCR） assay, respectively. Univariate analysis and unconditional logistic regression analysis were used to explore the risk factors on intrauterine transmission. Results Among 344 neonates born to HBsAg-positive mothers, 42 were validated as HBV intrauterine transmitted, with the rate of intrauterine transmission as 12.21% （42/344）. The rates of intrauterine transmission among HBeAg-positive and HBeAg-negative mothers were 18.52% （30/162） and 6.59% （12/182）, respectively. The rates of intrauterine transmission were 22.22% （34/153） and 4.19% （8/191） in the groups of vaginal birth or caesarean delivery, respectively. Results from unconditional logistic regression analysis showed that after adjusting the confounding factors, HBeAg-positive mothers （OR=3.003, 95%CI： 1.368-6.593） and vaginal birth （OR=7.333, 95%CI： 3.108-17.302） might serve as the risk factors for the HBV intrauterine transmission. Data from the interaction analysis showed that there were additive interactions Erelative excess risk due to interaction （RERI） as 14.229; the attributable proportion （AP） due to interaction as 0.587; the synergy index （SD as 2.5791 and multiplicative interaction （OR= 1.084, 95%CI： 0.720-1.632） between HBeAg status and the modes of delivery. Conclusion Vaginal birth and HBeAg-positive might serve as the risk factors for HBV intrauterine transmission. There also appeared additive interactions between HBeAg status and the mode of delivery.

关 键 词：乙型肝炎病毒宫内传播 乙型肝炎E抗原 分娩方式 交互作用 

分 类 号：R714.251[医药卫生—妇产科学]