个体化方案阻断乙型肝炎病毒母婴传播十年数据分析  被引量:1

Analysis on ten-year data of individualized programs to prevent mother-to-child transmission of hepatitis B virus

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作  者:张荣 唐雍艳 喻茜[2] 丁志云[3] 朱莉[4] 姚杰[1] 赵继[2] 张玉 马德明 张丽娜 姚小英 丁善文[1] 石尚虎 贾玉芳[3] 沈静[3] 王海燕[4] 龚婵聪 沈秀娟[4] 李明[4] 钱峰[4] 朱传武[4] Zhang Rong;Tang Yongyan;Yu Qian;Ding Zhiyun;Zhu Li;Yao Jie;Zhao Ji;Zhang Yu;Ma Deming;Zhang Lina;Yao Xiaoying;Ding Shanwen;Shi Shanghu;Jia Yufang;Shen Jing;Wang Haiyan;Gong Chancong;Shen Xiujuan;Li Ming;Qian Feng;Zhu Chuanwu(Obstetrics Department,the Fifth People’s Hospital of Suzhou,Suzhou 215131,China;Kunshan Maternal and Child Health Institute,Kunshan 215300,China;Obstetrics Department,Kunshan Hospital of Traditional Chinese Medicine,Kunshan 215300,China;Department of Hepatology,the Fifth People’s Hospital of Suzhou,Suzhou 215131,China)

机构地区:[1]苏州市第五人民医院感染产科,苏州市215131 [2]昆山市妇幼保健所,昆山市215300 [3]昆山市中医医院产科,昆山市215300 [4]苏州市第五人民医院肝病科,苏州市215131

出  处:《中华实验和临床感染病杂志(电子版)》2021年第5期303-310,共8页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基  金:苏州市卫健委临床重点病种诊疗技术专项(No.LCZX201613);苏州市科学技术局民生科技项目(No.SS202068)。

摘  要:目的分析个体化方案对乙型肝炎病毒(HBV)母婴传播(MTCT)的阻断效果。方法苏州市第五人民医院肝病科和产科根据HBsAg阳性孕妇的HBeAg状态和HBV DNA水平,对国内肝病指南推荐的免疫阻断方案进行了优化和细化,形成了个体化免疫阻断方案。本研究收集2009年9月至2019年5月于本院分娩的所有HBsAg阳性孕妇的临床资料及其8~12月龄婴儿的HBV血清学标志物(观察组),均采用个体化方案进行MTCT阻断。同时,收集2015年2月至2019年7月于昆山市分娩的HBsAg阳性孕妇及其婴儿相应的临床和随访资料作为对照,对照组采用国内肝病指南推荐的免疫阻断方案。结果观察组共有2702例孕妇入组,分娩健康新生儿2717例(含15例双胎)。其中2345例新生儿(含12例双胎)接受了联合免疫治疗方案(方案1和方案2)进行阻断;369例孕妇采用核苷(酸)类似物(NAs)抗病毒治疗方案(方案3),分娩新生儿372例(含3例双胎)。对照组共2616例HBsAg阳性孕妇入组,分娩健康新生儿2620例(含4例双胎),均接受联合免疫治疗方案进行阻断。观察组共19例婴儿HBsAg阳性,均为HBeAg阳性孕妇所产婴儿。其母亲HBV DNA载量均>5log10IU/ml,其中>7log10IU/ml的孕妇占84.21%(16/19)。观察组总体母婴阻断失败率为0.70%(19/2717),总体免疫阻断失败率为0.81%(19/2345)。HBeAg阳性孕妇中总体阻断失败率为1.21%(19/1574),免疫阻断失败率为1.51%(19/1256),HBV DNA载量>7 log10IU/ml的孕妇免疫阻断失败率为1.69%(16/949)。HBeAg阴性、HBV DNA载量<5 log10IU/ml和应用NAs抗病毒预防治疗的孕妇,母婴阻断成功率均为100%。应用免疫阻断和NAs治疗组间母婴阻断失败率差异无统计学意义(P=0.096)。对照组共53例婴儿HBsAg阳性,总体母婴阻断失败率为2.02%(53/2620),显著高于观察组(χ^(2)=12.733、P<0.001)。其中,HBeAg阳性孕妇阻断失败率为2.87%(15/523),HBeAg阴性孕妇为1.81%(38/2097),均显著高于观察组,差异均有统计学意�Objective To investigate the effect of individualized programs on blocking mother-tochild transmission(MTCT) of hepatitis B virus(HBV). Methods Based on the status of HBeAg and HBV DNA level in HBsAg-positive pregnant women, the Department of Hepatology and Obstetrics of the Fifth People’s Hospital of Suzhou optimized and refined the immunoblocking programs recommended by the domestic guidelines for liver disease, and formed an individualized immune blocking schemes. The clinical data of all HBsAg-positive pregnant women hospitalized in our hospital from September 2009 to May 2019,and the HBV serological markers of their infants aged 8-12 months(observation group) were collected.Individualized programs were used to block MTCT of HBV. Meanwhile, the corresponding clinical and follow-up data of all HBsAg-positive pregnant women and their infants delivered in Kunshan city from February 2015 to July 2019 were collected as control group. The newborns of the control group were given the immunoprophylaxis recommended by the domestic guidelines for liver diseases. Results Total of 2 702 pregnant women were enrolled in observation group, and 2 717 healthy newborns(including 15 twins)were delivered. Among them, 2 345 newborns(including 12 twins) were treated with immunoprophylaxis measures(program 1 and 2);369 pregnant women were treated with nucleos(t)ide analogs(NAs) antiviral therapy(program 3), and 372 newborns(including 3 twins) were delivered. In control group, 2 616 pregnant women with HBsAg positive were enrolled, 2 620 healthy newborns(including 4 twins) were delivered and were given immunoblocking treatment. In observation group, 19 infants were detected positive for serum HBsAg, and their mothers were all with positive HBeAg. The HBV DNA loads of their mothers were all >5 log10 IU/ml, and the women with HBV DNA level > 7 log10 IU/ml accounted for 84.21%(16/19). The overall failure rate of blocking MTCT was 0.70%(19/2 717), and the overall immunoblocking failure rate was 0.81%(19/2 345). Among pregnant women wi

关 键 词:肝炎病毒 乙型 母婴传播 个体化方案 阻断 效果分析 

分 类 号:R714.251[医药卫生—妇产科学]

 

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