毕节市乙型肝炎病毒母婴阻断策略实施效果研究  

Study on Implementation Effect of PMTCT Programmes for Hepatitis B Virus in Bijie

作　　者：刘宁[1] 李全[2] 方拥 孙雨 LIU Ning(Bijie Center for Disease Control and Prevention,Guizhou Bijie 551700,China)

机构地区：[1]毕节市疾病预防控制中心,贵州毕节551700 [2]纳雍县疾病预防控制中心,贵州毕节551700 [3]金沙县疾病预防控制中心,贵州毕节551700 [4]赫章县疾病预防控制中心,贵州毕节551700

出　　处：《健康女性》2020年第16期1-4,共4页Women＇s Health

基　　金：毕节市科技基金项目(毕科合字[2014]38号)。

摘　　要：目的:了解毕节市乙型肝炎病毒母婴阻断策略实施状况及阻断效果。方法:选择发病率处于中等水平的纳雍、金沙、赫章三县作为观察现场,以2014年8月-2015年12月产前筛查出的HBsAg阳性住院分娩产妇及新生儿为观察对象。采集孕妇血标本、新生儿脐带血标本和7-12月龄婴儿血标本,分离血清后用酶联免疫吸附试验(ELISA)作HBV血清标志物(HBVM)检测,采用聚合酶链式反应(PCR)结合荧光探针的体外DNA扩增和检测技术,定量检测产妇血清标本中的HBV-DNA含量。结果:三个县共开展产妇HBsAg筛查10156人,发现HbsAg阳性产妇546人,阳性率为5.38%。共对288名产妇血清标本进行复测,发现HBVM有15种感染模式,以大三阳(HbsAg、HbeAg、HBcAb)和小三阳(HbsAg、HbeAb、HBcAb)的感染模式为多,分别占30.65%和33.33%。新生儿脐带血HBVM中,HbcAb阳性率91.67%,大三阳产妇HbeAg阳性率为75.00%。通过对209名产妇HBV-DNA载量检测,124名HBV-DNA载量阳性(>103copies/ml),阳性率59.33%,其中大三阳为97.01%、平均载量(x±s)为(6.89±1.53),小三阳为31.88%、平均载量(x±s)为(2.32±1.27)。对207名在册婴儿追踪调查,均在出生后24小时接种HepB1,并按0、1、6月免疫程序完成HepB全程接种,HbsAb阳性176人、阳性率85.02%,母婴阻断成功率为90.82%。结论:毕节市产妇HBV感染仍较严重,母婴阻断措施还需进一步加强。建议妇女怀孕前期应开展HBsAg检测,对未感染HBV或HBsAb阴性的育年期妇女及时接种HepH,对HBsAg阳性孕妇应开展HBVM和HBV-DNA检测,对HBV大三阳/小三阳、HBV-DNA阳性产妇其所生新生儿及时接种乙肝疫苗的同时,在出生后12h内及时注射乙肝免疫球蛋白,提高母婴阻断成功率。Objective:To investigate the implementation status and effect of the prevention of mother-to-child transmission(PMTCT)programmes for hepatitis B virus in Bijie City.Methods:Nayong,Jinsha,and Hezhang counties with moderate incidence rates were selected as the observation sites,and HbsAg positive women who were hospitalized for delivery from August 2014 to December 2015 and their newborns were selected as observation subjects.Blood samples of pregnant women,newborn umbilical cord blood and infants aged 7-12 months were collected and the serum was separated.Enzymelinked immunosorbent assay(ELISA)was used for detection of HBV markers(HBVM),and the polymerase chain reaction(PCR)combined with in vitro DNA amplification and detection technology through fluorescent probe were adopted to quantitatively detect the HBV-DNA content in parturients serum samples.Results:A total of 10156 parturients were screened for HBsAg in the 3 counties,and 546 were found to be HbsAg positive,with a positive rate of 5.38%.A total of 288 parturients’serum samples were retested,and 15 HBVM infection patterns were found,with HbsAg positive,HbeAg positive,HbcAb positive and HbsAg positive,HbeAb positive,HbcAb positive being the majority,accounting for 30.65%and 33.33%respectively.In HBVM of neonatal umbilical cord blood,HbcAb had a positive rate of 91.67%,and the positive rate of HbeAg was 75.00%in pregnant women suffering from HbsAg positive,HbeAg positive,HbcAb positive.By testing the HBV-DNA load of 209 parturients,124 had a positive HBV-DNA load(>103 copies/ml),with the positive rate of 59.33%,HbsAg positive,HbeAg positive and HbcAb positive of 97.01%,the average load(x±s)of(6.89±1.53);and the HbsAg positive,HbeAb positive,HbcAb positive of 31.88%,and the average load(x±s)of(2.32±1.27).A follow-up investigation was conducted on 207 registered infants,all of whom were inoculated with HepB124 hours after birth,and HepB inoculation was completed in accordance with the immunization procedure at month 0,1 and 6.Among them,176 were HbsAb po

关 键 词：乙型肝炎 母婴阻断 乙肝疫苗 乙肝免疫球蛋 

分 类 号：R51[医药卫生—内科学]