乙型肝炎孕妇感染标志物与新生儿感染相关性分析
摘要
目的分析2013-2016年在巴南区人民医院分娩的乙型肝炎孕妇及其新生儿乙型肝炎感染状况。方法回顾分析2013-2016年在该院分娩的716例乙型肝炎孕妇及其新生儿乙型肝炎相关检测指标。结果 716例新生儿中,22例乙型肝炎表面抗原(HBsAg)阳性,宫内感染率为3.07%;其中545例乙型肝炎小三阳母亲的新生儿中有10例(1.83%)HBsAg阳性,171例乙型肝炎大三阳母亲的新生儿中有12例(7.02%)HBsAg阳性;423例血乙型肝炎病毒基因(HBV-DNA)阴性的乙型肝炎母亲所生新生儿5例(1.18%)HBsAg阳性,293例血HBV-DNA阳性乙型肝炎孕妇所生新生儿17例(5.80%)HBsAg阳性;293例血HBV-DNA阳性孕妇,当血HBV-DNA<1.0×107 copies/mL、107~108 copies/mL及>108 copies/mL时其新生儿HBsAg的阳性率分别为0.69%、6.41%和15.49%;当孕妇血HBV-DNA载量>105 copies/mL时,其乳汁HBV-DNA检出率明显增加。结论乙型肝炎小三阳或HBV-DNA阴性乙型肝炎孕妇均可以发生宫内感染;乙型肝炎大三阳及HBV-DNA高病毒载量孕妇,胎儿宫内感染率高;当孕妇血HBV-DNA>107 copies/mL时,其所生新生儿宫内感染率明显增加,建议孕期可考虑抗病毒治疗;乳汁HBV-DNA阳性率随血HBV-DNA病毒载量升高而升高,母乳喂养需谨慎。
引文
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[2]JEMAL A,BRAY F,CENTER M M,et al.Global cancer statistics[J].CA J Clin,2011,61(2):69-90.
[3]LIANG X,BI S,YANG W,et al.Evaluation of the impact of hepatitis B vaccination among children born during1992-2005in China[J].J Infect Dis,2009,200(1):39-47.
[4]GUO Z,SHI X H,FENG Y L,et al.Risk factors of hbv intrauterine transmission among HBsAg-positive pregnant women[J].J Viral Hepat,2013,20(5):317-321.
[5]YIN W J,SHEN L P,WANG F Z,et al.Hepatitis B immunoprophylactic failure and characteristics of the hepatitis B virus gene in mother-infant pairs in parts of China[J].Biomed Environ Sci,2016,29(11):790-801.
[6]ZHANG L,GUI X,WANG B,et al.A study of immunoprophylaxis failure and risk factors of hepatitis B virus mother-to-infant transmission[J].Eur J Pediatr,2014,173(9):1161-1168.
[7]TONG C Y,ROBSON C,WU Y,et al.Post-vaccination serological test results of infants at risk of perinatal transmission of hepatitis B using an intensified follow-up programme in a London centre[J].Vaccine,2013,31(31):3174-3178.
[8]ZHANG H,PAN C Q,PANG Q,et al.Telbivudine or lamivudine use in late pregnancy safely reduces perinatal transmission of hepatitis B virus in real-life practice[J].Hepatology,2014,60(2):468-476.
[9]LIAW Y F,KAO J H,PIRATVISUTH T,et al.AsianPacific consensus statement on the management of chronic hepatitis B:a 2012update[J].Liver Int,2012,6(3):531-561.
[10]LOK A S,MCMAHON B J.Chronic hepatitis B:update2009[J].Hepatology,2009,50(3):661-662.
[11]LV N,CHU X D,SUN Y H,et al.Analysis on the outcomes of hepatitis B virus perinatal vertical transmission:nested case-control study[J].Eur J Gastroenterol Hepatol,2014,26(11):1286-1291.
[12]YIN Y,WU L,ZHANG J,et al.Identification of risk factors associated with immunoprophylaxis failure to prevent the vertical transmission of hepatitis B virus[J].J Infect,2013,66(5):447-452.
[13]ZHANG L,GUI X,FAN J,et a1.Breast feeding and immunoprophylaxis efficacy of mother-to-child transmission of hepatitis B virus[J].J Matern Fetal Neonatal Med,2014,27(2):182-186.
[14]彭其才,许成芳,腾奔琦,等.产妇血清HBV DNA含量对乳汁和新生儿血清HBV DNA浓度的影响[J].中山大学学报(医学科学版),2010,31(5):729-731.
[15]代允普,郭艳霞,张彬.乙型肝炎垂直传播危险性量化研究[J].中国卫生检验杂志,2010,20(11):3056-3057.
[16]WU Q,HUANG H,SUN X,et al.Telbivudine prevents vertical transmission of hepatitis B virus from women high viral loads:aprospective long-term study[J].Clin Gastroenterol Hepatol,2015,13(6):1170-1176.
[17]YU M M,JIANG Q,JI Y,et al.Comparison of telbivudine versus lamivudine in interrupting perinatal transmission of hepatitis B virus[J].J Clin Virol,2014,61(1):55-60.
[18]HAN G R,JIANG H X,YUE X,et al.Efficacy and safety of telbivudine treatment:an open-label,prospective study in pregnant women for the prevention of perinatal transmission of hepatitis B virus infection[J].J Viral Hepatol,2015,22(9):754-762.