基于个体化方案的乙型肝炎病毒母婴垂直传播阻断对选择性剖宫产分娩的影响  

Effect of blocking mother-to-child vertical transmission of HBV on selective cesarean section based on individualized scheme

作　　者：张荣 钱峰[2] 朱莉[2] 姚杰[1] 唐雍艳 张玉 马德明 张丽娜 姚小英 温娅 朱月萍[2] 王银玲 王海燕[2] 陈帆 李明[2] 朱传武[2] Zhang Rong;Qian Feng;Zhu Li(Obstetrics Department,the Fifth People’s Hospital of Suzhou,Suzhou 215131)

机构地区：[1]苏州市第五人民医院感染产科,江苏苏州215131 [2]苏州市第五人民医院肝病科,江苏苏州215131

出　　处：《中国现代医药杂志》2021年第2期37-41,共5页Modern Medicine Journal of China

基　　金：苏州市卫健委临床重点病种诊疗技术专项(编号:LCZX201613)。

摘　　要：目的应用个体化方案对乙型肝炎病毒(HBV)感染孕妇实施母婴传播阻断,分析选择性剖宫产率的变化及其影响因素。方法收集2009年9月~2019年5月在我院分娩的HBV感染孕妇的临床资料,同时收集其婴儿8~12月龄的HBV血清学标志物,分析HBV母婴阻断失败率、选择性剖宫产率及其影响因素。结果共有2 702例HBV感染孕妇在我院分娩,分娩新生儿2 717例(含15例双胎),其中19例婴儿血液HBsAg和HBeAg检测结果为阳性,母婴阻断失败率为0.70%(19/2 717)。阴道分娩1 507例,11例婴儿感染HBV;剖宫产分娩1 210例(含15例双胎),8例婴儿感染HBV。阴道分娩和剖宫产分娩的母婴阻断失败率分别为0.73%(11/1 507)和0.66%(8/1 210),两者差异无统计学意义(χ^(2)=0.046,P=0.831)。在剖宫产中,选择性剖宫产240例,婴儿感染1例,母婴阻断失败率为0.42%(1/240)。与上述失败率比较,三者间差异无统计学意义(χ^(2)=0.309,P=0.857)。选择性剖宫产率总体呈逐年下降趋势,2018年和2019年已为0。以2015年为时间界点,在2009~2014年和2015~2019年,选择性剖宫产率分别为14.86%(217/1 460)和1.85%(23/1 242),两者差异有统计学意义(χ^(2)=140.376,P=0.000)。是否进行HBV传播阻断干预及HBeAg阳性与选择性剖宫产率存在线性关系(P<0.05)。结论以个体化方案为基础的HBV母婴阻断显著提高了阻断成功率,选择性剖宫产率逐年下降,增强了孕妇选择自然分娩的信心。Objective Utilizing individualized scheme to block mother-to-child transmission(MTCT)of HBV,and analyze the rate change of elective cesarean section and its influencing factors.Methods The clinical data of HBV-infected pregnant women delivered in our hospital from Sep 2009 to May 2019 were collected,as well as the HBV serological markers of their infants aged 8~12 months.The failure rate of blocking HBV MTCT,the rate of selective cesarean section and its influencing factors were analyzed.Results A total of 2702 pregnant women delivered in our hospital,and gave birth to 2717 newborns(including 15 twins).Among the infants,19 newborns were positive for serum HBsAg and HBeAg.The failure rate of MTCT was 0.70%(19/2717).There were 1507 newborns vaginal delivery and 11 cases were infected with HBV,and 1210 newborns(including 15 twins)were cesarean delivery and 8 cases were infected with HBV.The failure rate was respectively 0.73%(11/1507)by vaginal delivery and 0.66%(8/1210)by cesarean delivery,there was no significant difference between them(χ^(2)=0.046,P=0.831).Two hundred and forty newborns were delivered by selective cesarean section and one case was infected.The failure rate of MTCT was 0.42%(1/240).Compared with the two failure rates above,there was no significant difference between them(χ^(2)=0.309,P=0.857).The rates of selective cesarean section showed a decreasing trend year by year,and reached zero in 2018 and 2019.Taking 2015 as the time cut-off point,the selective cesarean section rates were 14.86%(217/1460)and 1.85%(23/1242)in 2009~2014 and 2015~2019,respectively,with significant difference(χ^(2)=140.376,P=0.000).There was a linear relationship between intervention,HBeAg positive and the rate of selective cesarean section.Conclusion The individual scheme based HBV mother-to-child blocking measures significantly improve the blocking success rate,enhance the confidence of pregnant women to choose natural childbirth,selective cesarean section decreases year by year.

关 键 词：个体化方案 乙型肝炎病毒 母婴传播 分娩 选择性剖宫产 

分 类 号：R714.251[医药卫生—妇产科学]