佛山市乙型肝炎母婴阻断工作环节问题探讨

目的探讨佛山市乙肝母婴阻断工作中存在的问题，为完善进一步工作提供思路。 方法采用队列研究的方法，以2017年佛山市HBsAg阳性产妇13 672例及其所分娩13 982例活产儿为研究对象，通过回顾性病历采集及前瞻性的随访追踪的方法，全面了解影响乙肝母婴阻断工作的主要因素。 结果2017年佛山市产妇HBsAg阳性率为10.14%，感染孕妇中HBeAg阳性率为24.13%，孕期HBV DNA检测率约5%，其中抗病毒治疗63例；新生儿乙肝免疫球蛋白接种率为99.84%；婴儿在出生后1年内完成乙肝疫苗三针接种的比率为81.71%，在完成三针乙肝疫苗接种的儿童中按照0-1-6程序接种的比率为62.65%；母婴阻断结果追踪率为40.16%，追踪儿童中母婴阻断失败34例，失败率为0.61%；产妇年龄低、HBeAg阳性、HepB未全程及规范接种是母婴阻断失败的危险因素(P<0.05)。儿童明确未检测的主要原因是拒绝检查、不知道要检查、提前检查和检测未提供结果，占99.07%。 结论加强信息沟通及健康教育，落实乙肝病毒感染产妇孕期DNA检测及抗病毒治疗，提高儿童乙肝疫苗的规范接种率，将暴露儿童的乙肝两对半检测纳入儿童保健管理工作，是实现全市乙肝母婴零传播的重要措施。

Analyzing the problems of mother-to-infant transmission of hepatitis B virus in Foshan

ObjectiveTo investigate the issues in blocking the mother-to-infant transmission of hepatitis B virus. MethodsA total of 13, 672 HBV positive mothers and their 13, 982 newborns were enrolled in this cohort study in Foshan during 2017. We collected maternal and children′s information from the medical case management system. And we analyzed the influencing factors in blocking the mother-to-infant transmission of HBV. ResultsThe HBsAg positive rate of parturient was 10.14% in Foshan during 2017, the HBeAg positive rate was 24.13%, and the HBV DNA positive rate was about 5%. A total of 63 cases accepted antiviral treatment. The immunization globulin coverage rate was 99.84%. The rate of accepting 3 doses vaccination of HBV within one year after birth was 81.71%, and the rate of standardized vaccination was 62.65% (accepted vaccination at birth, one month and six month). The follow-up rate of all the fetus accepting HBV vaccine was 40.16%, and 34 (0.61%) fetus failed during the HBV blocking. The cause of blocking failure might included young age, HBeAg positive mothers and unregulated HBV vaccination. The main reason of clearly untested included refusal to examine the antibody, forgetting to examine the antibody, examine the antibody in advance, and couldn't provide test results accounted for 99.07%. ConclusionsIn order to realize zero transmission of HBV from mother to child in our city, we suggest to strengthen information communication and health education, implement HBV DNA detection and antiviral treatment for HBV positive pregnant women, increase the rate of standardized vaccination, and integrate this Hepatitis B two-and-a-half detection work of exposed children into the management of child health care.