母体乙肝病毒感染与新生儿黄疸关系的临床研究

目的探讨母体乙肝病毒感染与不同类型新生儿黄疸的关系。方法385例病理性黄疸新生儿患者根据母体乙型肝炎抗原阳性与否分为肝炎组与非肝炎组，比较两组患儿溶血性黄疸与G-6PD缺乏症黄疸比例，并比较不同黄疸类型情况下，两组患儿胆红素水平差异。结果（1）母体乙型肝炎抗原阳性者52例，乙型肝炎抗原阴性者333例。肝炎组与非肝炎组乙型新生儿溶血病，G6PD缺乏症以及其他原因导致溶血发生率分布情况差异有统计学意义（Y0：385．000，P〈0．001）。乙型肝炎抗原阳性组G6PD缺乏症阳性率为34．6％，乙型肝炎抗原阴性组G6PD缺乏症阳性率为22．5％。两组患儿新生儿溶血病阳性率差异相对比较小，分别为50．5％与42．3％。（2）G6PD缺乏症患儿中，母体乙型肝炎抗原阳性组最高总胆红素水平与乙型肝炎抗原阴性组差异有统计学意义（t=4．672，P〈0、01）。非G6PD缺乏症溶血，如新生儿溶血病与其他类型黄疸，母体乙型肝炎抗原阳性患儿组最高总胆红素水平与乙型肝炎抗原阴性组无显著差异（P〉0．05）。结论新生儿黄疸中，母体乙型肝炎抗原阳性者新生儿G-6PD缺乏症发生率高，并与G-6PD缺乏症病情有关。     

Prevention of vertical transmission of hepatitis B. The place of routine screening in antenatal care, and the case for immunization of infants at risk

Many chronic carriers of hepatitis B virus acquire the infection from their mothers at birth; the risk is greatest if the mother either has acute hepatitis B or is a hepatitis Be antigen (HBeAg)-positive HBsAg carrier, but there is some risk also to the infants of mothers who do not carry HBeAg. At the Royal Women's Hospital, Melbourne, nearly 2% of women attending antenatal clinics are found to be carriers and, without immunization, approximately five infants per 1000 infants delivered (up to 15 infants annually) would also become carriers. Vertical transmission of hepatitis B can be prevented by a combination of passive and active immunization if infants at risk can be identified at or before birth. Routine screening for hepatitis B surface antigen in pregnant women is recommended, at least in institutions in which the patient population includes a high proportion of migrants, in whom the prevalence of hepatitis B carriage is relatively high.     

Perinatal transmission of hepatitis B virus.

Transmission of hepatitis B virus from carrier mothers to their infants seems most likely to occur during birth. Both cord blood and breast milk have been found to be positive (in 35% and 72% of cases respectively) for hepatitis B surface antigen (HBsAg), but they do not appear to play an important role in transmission. To control this problem high-risk women should be tested during pregnancy for HBsAg. The infants of infected women should be given several doses of hepatitis B immunoglobulin starting at birth. In less developed regions, where hepatitis B is endemic, administration of the immunoglobulin in combination with vaccine, or even the vaccine alone, may be preferable in order to provide infants with lasting protection.     

婴儿乙型肝炎疫苗免疫效果评价

目的评价婴儿接种乙型肝炎疫苗的效果。方法回顾性分析2002—2012年北京市顺义区母亲为乙肝表面抗原（HBsAg）阳性和母亲为HBsAg阴性的婴儿（普通婴儿）接种乙肝疫苗后的血清学资料。结果224例母亲为HBsAg阳性的婴儿中,HBsAg阳性者5例,阳性率为2．2％;HBsAb阳性者204例。219例HBsAg阴性婴儿和165例普通婴儿的HBsAb阳性率分别为93.2％和99．4％。母亲HBsAg、HBeAg双阳性者、母亲单阳性者（HBsAg阳性）及母亲HBsAg阳性、HBeAg不详者,3组的免疫效果差异无统计学意义（P〉0．05）。母亲HBsAg阳性婴儿免疫效果比普通婴儿差（P〈0．01）。母亲为HBsAg阳性的婴儿接种10μg剂量进口疫苗和10μg剂量“搭配接种方案”的免疫效果均优于5μg国产疫苗（P〈0．05）。母亲HBsAg阳性是阻碍婴儿HBsAb产生的影响因素（OR=0．086,P=0．035）。结论顺义区现行乙肝免疫策略对母亲为HBsAg阳性的婴儿免疫效果较理想,但较普通婴儿效果略差。     

乙肝病毒转录体检测在母婴传播中的应用

目的探讨乙型肝炎病毒(HBV)转录体的检测在母婴传播中的意义。方法自母亲及其婴儿血清中提取核酸,经PCR及RT-PCR分别扩增HBVDNA和RNA,琼脂糖凝胶电泳显示产物,South-ern-blotting验证反应的特异性,取代表性产物克隆、测序。结果HBeAg(+)母亲的XDNA的表达(75.0%)和fRNA的表达(65.0%)显著高于HBeAg(-)的母亲(分别为37.5%和20.8%,P<0.05和P<0.005);所有表达fRNA的母亲也同时表达trRNA,在20例XDNA(-)、fRNA(-)的母亲中,仍有10例可检测到trRNA。新生儿XDNA的表达(4.6%)和fRNA的表达(6.8%)较其母亲显著降低;占优势表达的是trRNA(52.3%),且与其母亲trRNA的表达状态密切相关。母亲为trRNA(+)的新生儿trRNA的表达显著高于母亲为trRNA(-)者。15例HBsAb(+)的新生儿均未检出XDNA和fRNA,但11例仍可检测到trRNA。结论与HBVDNA及其表达产物相比,trRNA在HBV母婴垂直传播过程中有可能是一个出现更早期的可检测指标,它有助于更精确的确定新生儿HBV感染的状态。     

HBV携带产妇血清、乳汁HBV-DNA载量状态与实施母乳喂养安全性的研究

目的：探讨HBV携带产妇血清、乳汁HBV-DNA载量的不同状况与实施母乳喂养安全性的关系.方法：检测产妇血清、乳汁及婴儿血标本HBV-DNA载量.对母乳和人工两种喂养方式婴儿做追踪观察.结果：HBsAg、HBeAg双阳性产妇的血清、乳汁HBV-DNA阳性率分别为100%、49.45%（P＜0.01）.两种喂养方式婴儿的HBV感染率为15.63%和13.56%,无显著性差异;婴儿抗-HBs检测,母乳组抗体几何平均滴度（GMT）明显高于人工喂养组;结论：HBV携带产妇乳汁HBV-DNA阳性率和病毒载量明显低于血清.母乳喂养不影响母婴传播阻断效果,且有助于提高婴儿抗-HBs的GMT水平.     

HBV-DNA检测与母乳喂养安全性相关研究

目的通过比较HBs—Ag、HbeAg双阳性患者母亲采用不同喂养方式的新生儿感染状况,探讨HbeAg阳性产妇母乳喂养的安全性。方法检测HBs—Ag、HbeAg双阳性产妇血清HBV—DNA和乳汁HBV—DNA,乳汁HBV—DNA阳性产妇所产婴儿以自愿为原则分别采用母乳喂养和人工喂养。所有新生儿均在生后4～6h内注射HBIG和乙肝疫苗。结果血清HBV—DNA为10^3～10^5、10^6--10^8、〉10^8组产妇乳汁HBV—DNA阳性率分别为19．23％、50．00％、83．33％。乳汁阳性产妇中,母乳喂养组婴儿HBs-Ag阳性率为14．29％,人工喂养组婴儿HBs-Ag阳性率为12．00％。结论产妇乳汁HBV-DNA阳性率与产妇血清HBV-DNA定量呈正相关。经联合免疫阻断母婴HBV传播后,母乳喂养与人工喂养同样安全。     

181例全程联合免疫阻断hBV母婴传播效果观察

目的：观察乙型肝炎人免疫球蛋白与乙肝疫苗全程联合应用对乙型肝炎表面抗原（ hbsAg）携带者母亲所生的婴儿（以下指高危人群）阻断乙肝病毒（ hBV）母婴传播,提高高危人群免疫效果。方法：181例hBsAg携带者母亲分娩的婴儿,根据自愿接种的原则分成两组。观察组出生后4h内婴儿大腿前部外侧肌注乙型肝炎人免疫球蛋白100 IU,并分别于出生后24 h内、1个月和6个月三角肌肌注重组乙肝疫苗（酵母）10μg。对照组于出生后24 h内、1个月、6个月分别三角肌肌注重组乙肝疫苗（酵母）10μg。婴儿7月龄时检测hBsAg。结果：观察组血清hBsAg阳性率为4.63％,明显低于单独使用乙肝疫苗的对照组17.81％。结论：采用乙型肝炎人免疫球蛋白与乙肝疫苗全程联合应用,对阻断hBsAg携带者母亲分娩的婴儿hBV母婴传播,提高高危人群免疫效果明显。     

Vertical transmission of hepatitis B virus: propositions and future directions

Chronic hepatitis B virus (HBV) infection due to vertical transmission remains a critical concern with regards to eliminating HBV infection. Implementation of hepatitis B vaccine, the foundation to prevent perinatal and horizontal transmission, has reduced the prevalence of HBV by >80%. In countries where the hepatitis B immune globulin (HBIG) is available, such as China and the United States, the administration of HBIG and hepatitis B vaccine to the infants of mothers who are positive for hepatitis B surface antigen has become a standard practice and is effective in preventing vertical transmission. Accumulating evidence on the efficacy and safety of antiviral prophylaxis during pregnancy indicates the probability of attaining the goal of the World Health Organization to eliminate hepatitis by 2030. In this review, we discuss the transmission routes, diagnostic criteria, and preventive strategies for vertical transmission. A preventive program that includes screening before pregnancy, antiviral prophylaxis during pregnancy, and postpartum immunoprophylaxis provides “perfect strategies” to eliminate vertical transmission. However, there is still a notable gap between “perfect strategies” and real-world application, including insufficient coverage of timely birth dose vaccine and the efficacy and necessity of HBIG, especially in mothers who are negative for hepatitis B envelope antigen. In particular, there is a clear need for a comprehensive long-term safety profile of antiviral prophylaxis. Therefore, feasible and cost-effective preventive strategies need to be determined across regions. Access also needs to be scaled up to meet the demands for prophylaxis and prevalence targets.     

Efficacy of a mass hepatitis B vaccination program in Taiwan. Studies on 3464 infants of hepatitis B surface antigen-carrier mothers

To evaluate the efficacy of the mass hepatitis B vaccination program in Taiwan in interrupting perinatal hepatitis B virus transmission, 3464 randomly selected 18-month-old infant vaccinees born to hepatitis B surface antigen-carrier mothers were recruited from 9697 eligible infants during a six-month period of the program. They were divided into ten groups according to maternal infectivity and compliance with the vaccination schedule. Serum samples were tested for hepatitis B surface antigen, antibody to hepatitis B surface antigen, and antibody to hepatitis B core antigen. In 786 infants who had highly infectious mothers and who received hepatitis B immune globulin and vaccine on schedule, the protective efficacy was about 85%. The efficacy seemed to be slightly lower in those immunized off schedule. Overall, 11% of infants still carried hepatitis B surface antigen, and 81% of the infants had antibody to hepatitis B surface antigen that exceeded 10 mIU/mL in more than 90% of them. The geometric mean titers of antibody to hepatitis B surface antigen were more than 200 mIU/mL in every group of infants. We conclude that the mass vaccination program is efficacious in preventing perinatal hepatitis B virus transmission and the chronic carrier state; most infant vaccinees have adequate levels of protective antibody at 18 months of age. This program is extremely significant in the control of hepatitis B virus infection in Taiwan.     

HBsAg阳性母亲的婴儿乙肝疫苗免疫效果评价

目的 探讨HBsAg阳性母亲的婴儿乙肝疫苗免疫的最佳时机.方法 将孕期检测HBsAg单阳性的母亲所产的健康婴儿65例,分为对照组和实验组,分别于出生后24 h内、3月龄时开始乙肝疫苗0,1,6月3针免疫,全程免疫后1、6、12、24个月时以RIA法检测抗-HBs滴度.结果 3月龄时开始免疫组全程免疫后1、6、12、24个月时抗-HBs滴度均高于出生后24 h内免疫组.结论 HBsAg单阳性的母亲所产的健康婴儿3月龄时开始乙肝疫苗免疫效果较好.     

妊娠糖尿病母亲新生儿及健康巨大儿血糖、胰岛素和皮质醇水平的变化

目的 探讨妊娠糖尿病母亲新生儿及健康巨大儿微量血糖、血清胰岛素、皮质醇水平的改变。方法 采用微量法、电化学发光法分别检测31例妊娠糖尿病母亲新生儿(GDM组)、33例同期出生的健康足月巨大儿(巨大儿组)和35例同期出生的健康足月新生儿(对照组)微量血糖及血清胰岛素、皮质醇的含量,并进行统计学分析。结果 与对照组相比,GDM组、巨大儿组微量血糖明显降低,血清胰岛素、皮质醇水平均明显升高(P均＜0.05);与巨大儿组相比,GDM组中巨大儿微量血糖明显降低,血清胰岛素水平明显升高(P均＜0.05),血清皮质醇水平虽升高,但差异无统计学意义(P＞0.05)。结论 妊娠糖尿病母亲新生儿、健康巨大儿均存在微量血糖、胰岛素、皮质醇的异常,因此加强对孕妇孕前及孕期的健康指导有利于减少妊娠糖尿病及巨大儿的发生。     

乙型肝炎病毒携带产妇预防干预措施与母乳喂养的安全性研究

目的:调查乙型肝炎病毒(HBV)携带产妇的母乳喂养和人工喂养后婴儿血清HBV标志物(HBVM)的阳性率,为指导母乳喂养提供证据.方法:用ELISA法检测孕妇和婴儿血清中的HBVM,用荧光定量聚合酶链反应(PCR)法检测HBV携带产妇血清和初乳中HBV-DNA含量,并分析婴儿血清HBVM与母乳喂养和人工喂养的关系.结果:67例HBsAg抗原阳性(大、小三阳),产妇中,HBV血清‘大三阳'的产妇血液、初乳中HBV-DNA阳性率较高.母亲血清HBVM为‘大三阳'者分别占人工喂养组和母乳喂养组的41%和13%,两组间有显著性差异(P＜0.05);婴儿在12～18个月时作血清HBVM检测,人工喂养组和母乳喂养组婴儿血清抗-HBs阳性率分别为84%和87%,两组无显著性差异(P＞0.05).结论:只要对HBV携带产妇在孕期进行预防干预及对所产婴儿进行被动和主动免疫防范措施,HBV携带产妇的母乳喂养是相对安全的.     

乙肝免疫球蛋白阻断病毒母婴传播的效果观察

目的 :探讨高效价乙肝免疫球蛋白 (HBIG)阻断乙型肝炎病毒 (HBV)母婴传播的作用机理。方法 :将5 0例HBsAg阳性的孕妇随机分成两组 ,实验组 30例 ,分别自孕 2 8周、32周、及 36周肌肉注射HBIG2 0 0IU ,分娩后 2 4h内再注射HBIG 2 0 0IU 1次 ;对照组 2 0例 ,不用HBIG。两组孕妇所生婴儿均于出生后 2 4h内肌肉注射HBIG 10 0IU 1次 ,注射乙肝疫苗的时间和剂量均按正常婴儿的操作方案进行。母儿血清HBsAg ,HBeAg和抗 HBs用固相放免法检测 ,HBV DNA用荧光定量PCR检测。结果 :实验组婴儿血清HBsAg和HBV DNA检出率明显低于对照组 (P <0 .0 5 ) ;实验组婴儿抗 HBs阳性率显著高于对照组 (P <0 .0 5 )。结论 :孕妇于孕期多次注射HBIG进行被动免疫 ,可有效地阻断乙型肝炎病毒母婴传播 ,减少婴儿HBV感染率。     

乙型肝炎病毒母婴传播阻断效果研究

目的 为探讨我院实施两种不同方式进行母婴传播阻断的效果.方法 选取乙肝表面抗原阳性或乙肝e抗原和乙肝核心抗体(抗-HBC)阳性的母亲,将单用乙肝疫苗组分为对照组(102例),将孕期加用乙肝高效价免疫球蛋白(HBIG)产后联合使用乙肝疫苗组为治疗组(123例),并对两组的新生儿乙肝表面标志物进行随访一年.结果 对照组12月龄抗-HBs阳性率为86.27%,HBsAg阳性率12.7%,宫内感染率51.9%,免疫失败率22.6%;治疗组12月龄抗-HBs阳性率为96%,HBsAg阳性率4.06%,宫内感染率31.7%,免疫失败率12.8%.两组各项指标差异均有显著意义(P＜0.05).结论 乙肝疫苗联合孕期使用乙肝高效价免疫球蛋白(HBIG)可有效阻断乙肝病毒的母婴传播,值得推广.     

我国2006年至2008年巨大儿发生率调查及影响因素分析

目的了解我国新生儿出生体质量水平及巨大儿的发生率,探讨巨大儿发生的影响因素。方法采用整群随机抽样方法,自全国抽取了5个省份中的5个城市为研究现场,每个城市抽取一个或几个社区为城市人群,一个乡镇或自然村为农村人群。调查对象是自2006年1月1日至2008年12月31日出生的婴幼儿,有效人数为16 880。调查的主要内容有婴幼儿一般状况、父母一般情况、母亲孕产期健康状况、母亲流/引产情况等,用卡方和Logistic回归等方法进行统计分析。结果低出生体质量发生率为2.88%,巨大儿发生率为10.31%。男孩巨大儿发生率高于女孩（P〈0.01）,城市巨大儿发生率高于农村（P〈0.01）,5个地区的巨大儿发生率不同（P〈0.01）。单因素Logistic回归分析结果显示,婴儿性别、出生地区、母亲生育年龄、母亲文化程度、孕期疾病史、胎儿产期、引产史与巨大儿发生有关（P〈0.01或0.05）。多因素Logistic回归分析结果显示,男婴、城市出生、母亲生育年龄≥30岁、母亲文化程度高、胎儿过期产是巨大儿发生的危险因素（P〈0.01或0.05）。流产史和引产史与巨大儿发生无关（P〉0.05）。结论我国巨大儿发生率偏高,男性胎儿、城市人口、母亲生育年龄过大、母亲文化程度高、胎儿过期产会增加巨大儿发生的危险。     

孕晚期注射乙型肝炎免疫球蛋白阻断乙型肝炎病毒母婴传播的临床观察

目的：探讨HBsAg阳性和HBeAg阳性携带孕妇孕晚期应用乙型肝炎免疫球蛋白（HBIG）阻断乙型肝炎病毒（HBV）母婴传播的效果。方法：将孕妇分为双阳性组（A组）和单阳性组（B组）[HBsAg（＋）及HBeAg（＋）称为“双阳性”（A组）,HBsAg（＋）及HBeAg（-）称为“单阳性”（B组）];新生儿分为HBIG组和非HBIG组（对照组）;HBIG组孕妇孕28、32、36周各注射HBIG200IU（共3次,部分仅注射1～2次）,非HBIG组仅常规产检及监护;对两组新生儿0、6个月的静脉血作乙型肝炎两对半检测。结果：①A组孕妇的外周血HBV-DNA阳性率（76.92%）显著高于B组孕妇（8.55%）,P〈0.01;②A组孕妇所生HBIG组新生儿出生24h的HBsAg阳性率（10.64%）显著低于非HBIG组（33.33%）,P〈0.05;③A组孕妇所生HBIG组6月龄新生儿HBsAb阳转率（78.72%）明显高于非HBIG组（38.39%）,P〈0.01;B组孕妇所生HBIG组6月龄新生儿HBsAb阳转率（80.65%）高于非HBIG组（64.41%）,P〈0.05。结论：双阳性孕妇孕晚期应用HBIG可有效降低乙型肝炎宫内感染率;无论是双阳性还是单阳性孕妇,孕晚期应用HBIG可提高6月龄新生儿HBsAb阳转率。     

拉米夫定阻断乙型肝炎病毒母婴传播的疗效观察

目的:评价妊娠中期应用拉米夫定对乙型肝炎病毒(HBV)传播的影响及安全性,寻求最佳预防宫内传播的方法。方法:拉米夫定组52例孕妇于孕20~26周开始服用拉米夫定100mg/d至分娩后,乙型肝炎免疫球蛋白(HBIG)组61例孕妇于孕28周开始使用HBIG 200 IU行宫内阻断治疗,2组新生儿出生均予主、被动联合免疫,观察新生儿宫内感染发生情况、抗病毒疗效及母婴异常情况,随访到婴儿1岁,并分别在0、1、7、12个月龄时监测其血清HBVDNA、HBsAg和抗-HBs定量变化。数据行t检验和χ2检验。结果:拉米夫定组孕妇于分娩前HBV DNA显著下降(t=18.72,P<0.05),转阴率为34.6%,肝功能异常者全部恢复正常。该组52例新生儿随访至1月龄时HBsAg或HBV DNA均为阴性,宫内感染率为0,与HBIG组宫内感染率(14.8%)相比,差异有统计学意义(χ2=9.40,P<0.05)。2组婴儿1岁时的血清抗-HBS水平无差异(t=0.71,P>0.05),拉米夫定组HBV慢性感染为0,HBIG组9例宫内感染婴儿均为HBsAg、HBeAg、抗-HBc、HBV DNA阳性,2组孕妇及婴儿均未发现不良反应。结论:对于HBV水平较高的孕妇,妊娠中期采用拉米夫定降低病毒含量,阻断HBV母婴垂直传播(宫内传播及产时传播)是行之有效的,且用药安全,未见明显不良反应。     

乙型肝炎病毒S基因变异株在母婴向的选择性传播

目的 探讨乙型肝炎疫苗和乙型肝炎免疫球蛋白联合免疫失败的婴儿血清中HBVS基因变异与母亲血清中HBV DNA含量的关系。方法　应用Roche公司的LightCycler定量分析仪测定95例母亲血清中HBV DNA含量,应用PCR技术对免疫失败的7例婴儿及其母亲血清进行扩增,扩增后克隆测序。结果95例婴儿中有7例（7.4％）出生后1年内发生HBV感染,其母亲血清中HBV DNA水平显著高于未发生感染组。对此7对母婴的序列分析,发现1对母婴婴儿的优势株为母亲的弱势株,另有1对发生婴儿131位苏氨酸到丙氨酸变异。结论免疫失败与母亲血清中高病毒血症相关,且母婴间存在选择性传播。     

Perinatal outcome and antenatal care in a black South African population.

The relationship between perinatal outcome and antenatal care was investigated at King Edward VIII Hospital, Durban, by a case control retrospective study of pregnancy records in 165 perinatal deaths and 156 infants surviving the perinatal period. 82% of the mothers of live infants had booked for antenatal care compared with only 60% of those who experienced a perinatal death. Hospital booking was associated with a higher infant birthweight. For those who booked earlier there was no reduction in total perinatal mortality or the stillbirth:neonatal death ratio, and many of the mothers of highest risk failed to book. This suggests that the better perinatal outcome in booked mothers may have been secondary to the type of mother who chose to book, rather than the actual antenatal care. To help reduce perinatal mortality, methods must be employed which reach those mothers who are most likely to fail to book.