携带乙型肝炎病毒孕妇血清标志物模式、病毒载量和肝功能在母婴传播中的风险评估  

The effect of serum marker patterns,viral load and liver function of pregnant women with hepatitis B virus infection in evaluating the risk of mother-to-child transmission

作　　者：王玥琦 潘禹辰[1] 陶雪蓉 杨娜[1] 赵天业 王崇[2] 吴燕华 姜晶[1] Wang Yueqi;Pan Yuchen;Tao Xuerong;Yang Na;Zhao Tianye;Wang Chong;Wu Yanhua;Jiang Jing(Division of Clinical Research,First Hospital of Jilin University,Changchun 130021,China;Department of Hepatology,First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院临床研究部,长春130021 [2]吉林大学第一医院肝胆胰内科,长春130021

出　　处：《国际流行病学传染病学杂志》2021年第1期7-12,共6页International Journal of Epidemiology and Infectious Disease

基　　金：国家重点研发计划(2017YFC0907405);吉林省科技发展计划(20200403098SF);吉林省教育厅"十三五"科学技术项目(JJKH20190026KJ)。

摘　　要：目的探讨HBsAg阳性妊娠期妇女HBV血清标志物模式、HBV DNA载量、ALT、AST与母婴传播阻断效果之间的关系,评估发生母婴传播的风险。方法选取2012年7月至2015年6月参加乙型肝炎母婴传播阻断项目的657例HBsAg阳性母亲及662例新生儿(含5对双胞胎)为研究对象,检测孕妇的HBV血清标志物、HBV DNA载量及肝功能指标,在新生儿7月龄时测定HBV血清标志物和HBV DNA,以探讨新生儿感染HBV情况与母亲孕晚期相关检测指标的关系。结果HBsAg/HBeAg双阳性组孕妇HBV DNA载量、ALT和AST异常比例显著高于HBeAg阴性组孕妇(HBV DNA:1×108vs.850 IU/mL,Z=-21.554,P<0.01;ALT:13.1%vs.6.6%,χ^(2)=7.536,P<0.01;AST:17.2%vs.5.5%,χ^(2)=20.780,P<0.01);HBsAg和抗-HBc阳性组孕妇HBV DNA水平显著高于HBsAg、抗-HBe和抗-HBc阳性组孕妇(1745 vs.804 IU/mL,Z=-2.313,P<0.05);随病毒载量的升高,ALT及AST异常率呈现逐步上升的趋势(χ^(2)趋势=19.309和32.502,P均<0.01)。接受主被动联合免疫后,仅HBeAg阳性,且HBV DNA>2×10^(5)IU/mL母亲分娩的16例新生儿发生了感染。结论HBeAg阳性和HBsAg/抗-HBc阳性孕妇的目前主被动免疫阻断方案疗效较差,建议HBeAg阳性和HBsAg/抗-HBc阳性且HBV DNA>2×10^(5)IU/mL者,需要密切观察病毒载量水平,并给予孕晚期抗病毒治疗,以降低肝损伤和母婴传播的发生风险。Objective To explore the relationship between HBV serum marker(HBV-M)patterns,HBV DNA load,ALT,AST and blocking effect of mother-to-child transmission in pregnant women with positive HBsAg,and to evaluate the risk of mother-to-child transmission.Methods A total of 657 mothers with positive HBsAg and 662 newborns(including 5 pairs of twins)who participated in the project of blocking mother-to-child transmission of hepatitis B were selected from July 2012 to June 2015.HBV-M,HBV DNA load and liver function indexes were detected in pregnant women.HBV-M and HBV DNA were detected in newborns at the age of 7 months,in order to explore the relationship between neonatal HBV infection and related laboratory indexes of late pregnancy.Results HBV DNA load,the proportions of abnormal ALT and AST in HBsAg/HBeAg positive group were significantly higher than those in HBeAg negative group(HBV DNA:1×108vs.850 IU/mL,Z=-21.554,P<0.01;ALT:13.1%vs.6.6%,χ^(2)=7.536,P<0.01;AST:17.2%vs.5.5%,χ^(2)=20.780,P<0.01).HBV DNA load in HBsAg/anti-HBc positive group was significantly higher than that in HBsAg/anti-HBe/anti-HBc positive group(1745 vs.804 IU/mL,Z=-2.313,P<0.05).With the increase of viral load,the rates of abnormal serum ALT and AST increased gradually(χ^(2)trend=19.309 and 32.502,P both<0.01).After receiving active and passive immunization,only 16 newborns were infected from mothers with positive HBeAg and HBV DNA>2×10^(5)IU/mL.Conclusions The blocking effect of active and passive immunization is poor in pregnant women with positive HBeAg or positive HBsAg/anti-HBc.It is suggested to closely monitor viral load and give antiviral therapy during late pregnancy in the pregnant women with positive HBeAg,HBsAg/anti-HBc and HBV DNA>2×10^(5)IU/mL,which can reduce the risk of liver function damage and mother-to-child transmission.

关 键 词：肝炎病毒 乙型 乙型肝炎血清标志物 肝功能 HBV DNA 母婴传播阻断 

分 类 号：R714.251[医药卫生—妇产科学]