HBV高载量孕妇不同分娩方式对母婴阻断的影响  

Effect of different delivery modes on interruption of mother-to-infant transmission in pregnant women with high HBV load

作　　者：郭咏梅[1] 冯涛 陈丽[1] 刘春华[1] GUO Yongmei;FENG Tao;CHEN Li;LIU Chunhua(Department of Obstetrics,Baoji Maternal and Child Health Care Hospital,Shaanxi Baoji 721000,China)

机构地区：[1]陕西省宝鸡市妇幼保健院产科,陕西宝鸡721000

出　　处：《中国妇幼健康研究》2020年第5期560-564,共5页Chinese Journal of Woman and Child Health Research

摘　　要：目的探讨乙型肝炎病毒(HBV)高病毒载量孕妇的分娩方式对母婴阻断效果的影响。方法选取2013年1月至2017年8月在陕西省宝鸡市妇幼保健院分娩的高HBV DNA载量(≥1×10^6copies/mL)孕妇186例作为研究对象,按照分娩方式将孕妇分为阴道分娩组和剖宫产组。婴儿在7~12月龄基本完成0-1-6月3针乙肝疫苗接种。出生时和接种完成后1个月,检测婴儿HBV血清学指标(HBsAg、HBeAg和HBV DNA载量)。根据检测结果判断免疫结局,分为母婴阻断失败、免疫成功和免疫无应答。结果 186例孕妇,阴道分娩(阴道顺产和产钳助产)和剖宫产(紧急剖宫产和选择性剖宫产)各93例,均单胎。剖宫产组婴儿出生时体质量高于阴道分娩组(t=3.953,P<0.05)。剖宫产组婴儿出生时HBsAg阳性率、HBeAg阳性率和HBV DNA水平>500×10^6copies/mL的比例分别为10.8%、92.5%和9.7%,阴道分娩组分别为9.7%、93.5%和12.9%,组间比较差异均无统计学意义(χ^2值分别为0.059、0.083、0.483,均P>0.05)。接种完成1个月后,剖宫产组免疫成功率、免疫无应答率和HBV感染率分别为91.4%、2.2%和6.5%,阴道分娩组分别为90.3%、1.1%和8.6%,组间比较差异均无统计学意义(χ^2值分别为0.065、0.339、0.309,均P>0.05)。结论剖宫产或经阴道分娩与HBV母婴垂直传播无明显相关性,对母婴阻断的效果无明显影响。HBV阻断失败的主要原因可能是宫内感染。Objective To investigate the effects of different delivery modes on interruption of mother-to-infant transmission in pregnant women with HBV high viral load.Methods From January 2013 to August 2017,186 pregnant women with high HBV DNA load(≥1×10^6copies/mL) delivered in Baoji Maternal and Child Health Care Hospital were selected and divided into vaginal delivery group and cesarean section group according to the mode of delivery.Their infants were basically inoculated with 3 shots of hepatitis B vaccine from 0 to 1 to 6 months at the age of 7 to 12 months.The serum HBV markers(HBsAg,HBeAg and HBV DNA load) were measured at birth and one month after the inoculation.According to the results of the test,the immune outcome was classified into failure of interruption of mother-to-infant transmission,successful immunization and immune nonresponse.Results Among 186 pregnant women,there were 93 cases of vaginal delivery(including vaginal delivery and forceps delivery) and 93 cases of cesarean section(including emergency cesarean section and selective cesarean section),all of them were singleton delivery.The body mass of newborn at birth in cesarean section group was significantly higher than that in vaginal delivery group(t=3.953,P<0.05).HBsAg positive rate,HBeAg positive rate and the proportion of HBV DNA level >500×10^6copies/mL were 10.8%,92.5% and 9.7% in caesarean section group,and 9.7%,93.5% and 12.9% in vaginal delivery group,there was no significant difference between the two groups(χ^2=0.059,0.083 and 0.483,respectively,all P>0.05).One month after the vaccination,the rate of successful immunization,immune nonresponse and HBV infection were 91.4%,2.2% and 6.5% respectively in the cesarean section group,and 90.3%,1.1% and 8.6% in the vaginal delivery group,respectively,there was no significant difference between the two groups(χ^2=0.065,0.339 and 0.309,respectively,all P>0.05).Conclusion There is no significant correlation between cesarean section or transvaginal delivery and the vertical transmission of HBV

关 键 词：乙型肝炎病毒 剖宫产 阴道分娩 母婴阻断 乙型肝炎疫苗 

分 类 号：R714.251[医药卫生—妇产科学]