妊娠晚期抗病毒治疗预防乙型肝炎病毒母婴传播：利还是弊？  

Clinical analysis of 21 cases with short fetal femur in the third trimester

作　　者：周乙华[1] 胡娅莉[2] 

机构地区：[1]南京大学医学院附属鼓楼医院感染病科,210008 [2]南京大学医学院附属鼓楼医院妇产科,210008

出　　处：《中华妇产科杂志》2017年第2期82-85,共4页Chinese Journal of Obstetrics and Gynecology

摘　　要：预防乙型肝炎病毒（hepatitis B virus,HBV）母婴传播是控制慢性乙型肝炎的关键.目前,我国对所有新生儿均免费接种乙型肝炎疫苗,并对HBsAg阳性孕妇分娩的新生儿在出生12 h内免费注射100 U乙型肝炎免疫球蛋白（hepatitis B immunoglobulin, HBIG）[1],但仍存在着预防失败,主要原因是母体高病毒载量,即HBV DNA≥106拷贝/ml.最近,孕晚期口服抗HBV药物以减少母婴传播成为研究热点,现对相关问题论述如下.Objective To analyze the clinical features and to explore the etiology of short fetal femur during the third trimester. Methods From January 2010 to June 2016, 21 singleton pregnancies with short fetal femur detected by ultrasonography during the third trimester were referred to the Chinese PLA General Hospital. Clinical data were collected, karyotype or single nucleotide polymorphism microarray was carried out to detect chromosomal abnormalities, and FGFR3 c.1138G〉A mutation detection was carried out to detect achondroplasia（ACH）via invasive procedure, respectively . The deviation of femur length from the mean value of the gestational age in ultrasonography was expressed as the Z-score. The difference between ACH and isolated short femur （ISF,in the absence of associated structure abnormality or genetic abnormality） was then explored. Results In the 21 fetuses, 11 had abnormal genetic test results（52%,11/21）, including 9 cases of ACH, 1 case of Ellis-van Creveld Syndrome and 1 case of Pallister-Killian syndrome. In the 10 ISF fetuses （48%,10/21）, 3 cases were fetal growth restriction, 1 was normal small for gestational age infant and 6 cases were unexplained. The median Z-scores for 9 cases of ACH and 10 cases of ISF in the third trimester were -5.04,-3.20, respectively. The short femur in ACH was more severe than in ISF （P=0.005） in the third trimester. Conclusions The etiology of short fetal femur is complicated, including skeletal dysplasia, chromosomal abnormality, fetal growth restriction, as well as normal variants during fetal development. Genetic test should be considered during the antenatal consultation.

关 键 词：乙型肝炎病毒 母婴传播 抗病毒治疗 预防 妊娠晚期 HBSAG阳性孕妇 乙型肝炎免疫球蛋白 抗HBV药物 

分 类 号：R714.251[医药卫生—妇产科学]