羊膜腔穿刺对乙型肝炎病毒母婴传播影响的回顾性队列研究

母婴传播是慢性乙型肝炎(简称乙肝)病毒(hepatitis B virus,HBV)感染的主要途径之一,约占所有新发感染的50%。预防HBV母婴传播对控制乙肝流行状态具有重要的意义。目前广泛实施的新生儿主-被动联合免疫主要针对围产期HBV母婴传播,而对HBV宫内感染的作用有限。HBV宫内感染的具体发病机制不明,可能与胎盘渗漏、胎盘感染或外周单核细胞传递等因素有关。     

乙肝病毒携带状态的表现特征和防治近况

乙肝病毒携带者流行率在西非和东方一些地区较高;一般达15～20%,日本母婴传播率达26.5%,女性乙肝易迁延化、慢性化、病理变化严重者多于男性。本文对血清标志和临床的联系、传播特征和机理及母婴乙肝病毒感染防治研究的进展作一综述。HBvac主动免疫预防法第二针后90%,第三针后95%以上获抗-HBs应答,抗-HBs水平高低,维持时间长短和疫苗保护之间密切相关。但认为疫苗对婴儿和产后母婴传播的保护率较好,母婴围产期感染或宫内感染则主张联合预防。母婴HBV感染的治疗有抗病毒疗法(主要用于母亲和较大儿童)和免疫疗法;免疫抑制剂(用于重症慢活肝)、免疫激活剂(用于免疫缺陷或HBV清除能力低下者)、D-青霉胺和中西药结合疗法。目前对选择和疗效尚有争议。     

联合免疫后HBV携带者母乳喂养的安全性研究

我国是病毒性肝炎的高发地区，其中主要是乙型病毒性肝炎。在乙肝高发地区，慢性HBV携带者多始于婴儿及儿童期的感染，所以人们担心慢性HBV感染的母亲在长达数月的哺乳期将病毒传染给婴儿。这种情况能否母乳喂养意见不一致.为此，我们回顾分析母亲在妊娠期接受HBIG，新生儿出生后接受主、被动联合免疫后婴儿HBV感染情况，探讨接受免疫阻断措施后母乳喂养的安全性。     

7766例孕产妇乙型肝炎病毒感染的检测结果分析

目的 探讨吴江地区孕产妇乙型肝炎病毒的感染和免疫保护状况,为重点人群乙肝的预防和控制提供科学依据。方法 选取在本地区各医院进行初次产前检查,并有完整产检和分娩信息的7766例孕产妇作为研究对象,初次产检时对孕妇抽取的血清样本进行乙肝两对半（五项指标）检测,并进行部分肝功能指标的检测,对各项检测结果进行分类统计。结果 各年龄段孕产妇乙肝表面抗原（HBsAg）阳性率经比较,随孕产妇年龄增长HBsAg阳性率逐渐升高;本省户籍组HBsAg阳性率为2.12%低于非本省户籍组的4.08%,肝功能异常组的HBsAg阳性率为12.82%高于肝功能正常组的3.00%,差异有统计学意义（P<0.05）。结论 本地区孕产妇乙肝病毒携带率仍较高,乙肝免疫保护程度较低,需要做好孕产妇乙型肝炎病毒的早期筛查工作,可针对HBsAg阳性的孕产妇及时采取正确有效的干预措施,以改善预后。     

美国母胎医学会“妊娠期乙型肝炎的筛查、治疗及垂直传播的预防指南”要点解读

正乙型肝炎是由乙型肝炎病毒(hepatitis B,HBV)引起的一种严重危害人类健康的疾病,全世界的感染人数超过了24 000万。在美国,妊娠妇女群体中的HBV感染率约为0.7%~0.9%~([1-2])。宫内和围产期垂直传播是全球HBV传播的重要组成部分。研究表明,35%~50%的HBV携带者是由于围产期接触受感染的血液及其污染物而受到感染~([1])。预防受感染孕妇的HBV垂直传播给胎儿,对减少     

妊娠合并乙型病毒性肝炎的母婴传播与阻断

乙型肝炎病毒感染(乙肝)是我国现阶段最严重的公共卫生问题之一.卫生部2006年全国人群乙肝流行病学调查,1～59岁人群HBsAg携带率为7.18%,其中5～14岁人群为2.42%,1～4岁人群为0.96%;1～4岁和5～14岁调查人群乙肝疫苗全程接种率为89.39%和50.59%,说明自1992年我国乙肝疫苗纳入儿童计划免疫管理和2002年乙肝疫苗纳入儿童免疫规划后取得了良好的效果,但出生后对新生儿施行乙肝疫苗和乙肝高效免疫球蛋白(HIG)联合免疫对已发生的宫内感染还是不能预防.     

孕妇主动与被动联合免疫预防乙型肝炎病毒宫内感染的临床研究

目的 探讨孕妇主动与被动联合免疫预防乙型肝炎病毒（ＨＢＶ）宫内感染的作用和机理。方法 将５３例ＨＢｓＡｇ（＋）孕妇分成两组，预防组３０例，自孕２０周起多次注射乙肝疫苗（ＨＢＶａｃ）和乙肝免疫球蛋白（ＨＢＩＧ）；对照组２３例，不用ＨＢＶａｃ和ＨＢＩＧ。母儿血清ＨＢｓＡｇ，ＨＢｅＡｇ和抗－ＨＢｓ用固相放免法检测，ＨＢＶ－ＤＡＮ用套式ＰＣＲ检测。结果 预防组新生儿血清ＨＢｅＡｇ和ＨＢＶＤＮＡ检出率明显低     

妊娠期高血压合并乙肝孕妇肝功能指标变化及对妊娠结局的影响

目的 探讨妊娠期高血压合并乙型肝炎（乙肝）孕妇肝功能指标变化及对妊娠结局的影响。方法 选取50例妊娠期高血压孕妇为研究组,根据是否合并乙肝分为妊娠期高血压组（32例）与妊娠期高血压合并乙肝组（18例）;另选取同期在医院分娩的50例健康孕妇为正常妊娠组。检测三组孕妇丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、总胆红素（TBIL）、总胆汁酸（TBA）,并比较三组妊娠结局情况。结果 妊娠期高血压合并乙肝组ALT、AST、TBIL及TBA指标明显高于妊娠期高血压组,而妊娠期高血压组高于正常妊娠组,差异具有统计学意义（P<0.05）。妊娠期高血压合并乙肝组早产、剖宫产、产褥感染、产后出血发生率均低于妊娠期高血压组与正常妊娠组,差异有统计学意义（P<0.05）,而妊娠期高血压组与正常妊娠组妊娠结局比较,差异无统计学意义（P>0.05）。结论 妊娠期高血压合并乙肝孕妇肝功能损伤明显,会增加不良妊娠结局发生率。     

围产期B族链球菌感染筛查与诊治

B族链球菌（GBS）是一种革兰阳性球菌,在围产期感染中占据重要地位,可导致多种围产期不良结局。国外已通过开展围产期GBS筛查及积极的干预措施,使母儿预后得到了明显改善,但我国对GBS的研究起步晚,目前由于世界各国对GBS的研究报道结果差异大,我国尚没有统一的筛查策略。文章阐述GBS筛查 的现状和在我国开展GBS筛查存在的一些争议。     

妊娠合并乙型肝炎病毒感染与母儿预后的关系

乙型病毒性肝炎(乙肝)是一种常见传染病，我国是乙肝高发区，感染率达10％。妊娠合并乙肝是常见的高危妊娠之一，对母亲可致产后出血、DIC，甚至引起孕产妇死亡，对围生儿可致早产、死胎、新生儿死亡和母婴传播。为探讨妊娠期HBV感染对母儿的影响，本文对我院147例妊娠合并HBV感染的病例进行回顾性分析，现报道如下。     

妊娠合并乙型肝炎病毒感染围分娩期管理

对乙型肝炎(乙肝)病毒感染孕妇采取合理的围分娩期管理以阻断母婴垂直传播是降低我国慢性乙肝感染率的关键。新生儿出生后及时注射乙肝免疫球蛋白,并按照0、1、6方案接种乙肝疫苗,可有效阻断乙肝的围分娩期传播。孕妇在晚孕期进行抗病毒治疗可能通过降低母体病毒水平而减少围分娩期传播风险,但抗病毒药物对胎儿的安全性仍需进一步验证。     

Chronic hepatitis B infection and pregnancy

It is estimated that 350 to 400 million individuals worldwide are chronically infected with hepatitis B virus (HBV). In regions of high endemicity, many of these are females of reproductive age who are an important source for perinatal transmission. There are a number of issues specific to the women of childbearing age who have chronic HBV infection, including the safety of antiviral therapy during pregnancy and breast-feeding, the changes in the immune system during pregnancy and postpartum that may impact on the natural history of HBV, and the emerging role of antivirals to reduce perinatal transmission of HBV. For women in their reproductive years who require treatment, many of the available antivirals have not been studied in pregnant or breast-feeding women and their use requires the development of a carefully considered strategy, considering the impact of both the disease and treatment on the mother and fetus/infant. The purpose of this article is to (1) review data regarding the mechanisms and timing of perinatal HBV infection; (2) review data on interventions, particularly antiviral therapy, to reduce perinatal transmission beyond the protection afforded by hepatitis B immunoglobulin and vaccination; (3) summarize the immunological changes associated with pregnancy and the potential effect these may have on the natural history of HBV infection; and (4) summarize the information currently available for antiviral therapy available for HBV treatment, focusing specifically on safety data pertaining to reproduction, pregnancy, and breast-feeding. TARGET AUDIENCE: Obstetricians & Gynecologists and Family Physicians. LEARNING OBJECTIVES: After completing this CME activity physicians should be better able to classify the interventions to reduce mother-to-child transmission of hepatitis B including antivirals, caesarean section, hepatitis B immunoglobulin and hepatitis B vaccine, assess the immunological changes associated with pregnancy and the potential effect this may have on the natural history of HBV infection and apply the information currently available for antiviral therapy licensed for HBV treatment, focusing specifically on safety data in pregnancy and during breastfeeding.     

Risk of perinatal transmission of hepatitis B virus in Jordan

OBJECTIVES: To determine the risk of perinatal transmission of hepatitis B virus (HBV) in Jordan. METHODS: Plasma samples from 1000 pregnant Jordanian women were screened by ELISA for HBV markers (HBsAg, HBeAg, anti-HBe, anti-HBc and anti-HBs). RESULTS: HBsAg and HBeAg were detected in 4.3% and 0.1% of the pregnant women, respectively. The overall prevalence of antibodies was 6%, 11.1% and 7.5% for anti-HBe, anti-HBc and anti-HBs, respectively. Women were assigned to four groups according to the serological patterns of HBV markers: susceptible (85.9%), with acute infection (2.9%), with chronic infection (1.4%) and previously infected (9.8%). Most women were at the third trimester of pregnancy, therefore women with acute and chronic hepatitis at this gestational age were at risk of transmitting HBV infection to their newborns. Women who belonged to the low socio-economic class were at higher risk of HBV infection. CONCLUSIONS: Based on the results, we recommend screening women for HBV during pregnancy in order to identify HBV carriers. All newborns born to carriers should be vaccinated immediately after birth, both passively and actively. Also vaccination of HBV seronegative pregnant women is recommended.     

Preventing Neonatal Hepatitis B Infection During the Perinatal Period

In the United States, hepatitis B virus (HBV) infection is a growing problem with serious long-term consequences. Because previous vaccination programs have been ineffective in lowering the incidence of HBV, the U.S. Centers for Disease Control now recommend a comprehensive plan to reduce transmission of the virus. This article explores the epidemiology of HBV infection, the use of hepatitis B immune globulin and hepatitis B vaccines, and current recommendations for eliminating transmission of HBV during the perinatal period.     

Risk of hepatitis B transmission in breast-fed infants of chronic hepatitis B carriers

OBJECTIVE: To measure the rate of hepatitis B (HBV) transmission from chronic HBV carriers to breast-fed infants after immunoprophylaxis. METHODS: Since 1992, information on women with HBV during pregnancy has been collected in a prospective longitudinal study. Those HBV carriers and their infants participating in a county HBV immunoprophylaxis program were identified. Infants were followed for up to 15 months and examined for hepatitis B infection by hepatitis B surface antigen (HBsAg). RESULTS: A total of 369 infants born to women with chronic HBV met the inclusion criteria and received hepatitis B immune globulin at birth and the full course of the hepatitis B vaccine series. We compared 101 breast-fed infants with 268 formula-fed infants. There was no significant difference between the two groups with respect to the number of women who were positive for hepatitis B e antigen (HBeAg) (22% versus 26%, P =.51). Three women in the breast-feeding group had liver transaminase abnormalities, compared with six women in the formula-feeding group (P =.29). Overall, there were nine cases of HBV infection transmission (2.4%). None of the 101 breast-fed infants and nine formula-fed infants (3%) were positive for HBsAg after the initial vaccination series (P =.063). The mean length of time for breast-feeding was 4.9 months (range 2 weeks to 1 year). CONCLUSION: With appropriate immunoprophylaxis, including hepatitis B immune globulin and hepatitis B vaccine, breast-feeding of infants of chronic HBV carriers poses no additional risk for the transmission of the hepatitis B virus.     

乙型肝炎表面抗原与乙型肝炎e抗原阴性孕妇乙型肝炎病毒宫内感染的研究

目的 探讨应用套式PCR方法检测乙型肝炎表面抗原(HBsAg)及乙型肝炎e抗原(HBeAg)阴性孕妇乙型肝炎病毒(HBV)宫内感染的状况。方法 选择HBsAg与HBeAg阴性,其他HBV血清标志物阳性孕妇及其新生儿24例作为病例组,同期HBV血清标志物全部阴性孕妇及其新生儿16例作为对照组。采用套式PCR方法检测两组孕妇及其新生儿的血清及外周血单个核细胞(PBMC)中HBV-DNA。结果(1)病例组24例孕妇中,血清HBV-DNA阳性8例,阳性率为33％;PBMC中HBV-DNA阳性10例,阳性率为42％r。其中血清与PBMC均阳性3例,总阳性率为63％r(15／24)。(2)病例组24个新生儿中,血清HBV-DNA阳性3例,阳性率为13％,PBMC中HBV-DNA阳性6例,阳性率为25％。其中血清与PBMC均阳性1例,宫内感染率为33％(8／24)。(3)病例组24例孕妇中,血清阴性而PBMC阳性共7例,其新生儿4例发生宫内感染,感染率为4／7。(4)对照组16例孕妇及其新生儿血清及PBMC中HBV-DNA全部阴性。结论 HBsAg及HBeAg阴性孕妇也可发生HBV宫内感染,采用灵敏度高的套式PCR方法检测孕妇及其新生儿血清及PBMC中HBV-DNA,对诊断HBV宫内感染具有重要临床意义。     

乙型肝炎病毒宫内感染相关因素的研究

目的探讨乙型肝炎病毒（HBV）宫内感染的相关因素、新生儿外周血单个核细胞（PBMC）及胎盘HBV感染的影响因素。方法分别采用酶联免疫吸附试验,检测151例血清HBsAg阳性孕妇HBV标志物及其新生儿血清HBsAg;PCR检测孕妇及其新生儿血清和PBMC中的HBV DNA;免疫组化ABC法检测孕妇胎盘组织中HBsAg。非条件logistic回归模型对孕妇血清HBV DNA阳性、孕妇PBMC HBV DNA阳性、胎盘HBV感染等73项危险因素进行分析。结果（1）151例血清HBsAg阳性孕妇分娩的151例新生儿中,血清HBsAg阳性5例,血清HBV DNA阳性29例,PBMC HBV DNA阳性36例,HBV标志物任一项阳性57例,宫内感染率为37．8％（57／151）。（2）HBV宫内感染的危险因素为孕妇血清HBV DNA阳性、孕妇PBMC HBV DNA阳性、胎盘HBV感染比值比（OR）分别为2．25（1．08～4．72）、2．69（1．26～5．73）、4．63（1．70～12．62）。（3）胎盘HBV感染的危险因素为孕妇血清HBV DNA阳性,OR为4．24（1．22—14．69）。（4）新生儿PBMC HBV DNA阳性的危险因素为孕妇PBMC HBV DNA阳性,OR为24．53（7．92～76．01）。结论孕妇PBMC和血清HBV DNA阳性及胎盘HBV感染为HBV官内感染的危险因素;孕妇PBMC HBV DNA阳性可能是形成新生儿宫内感染的独立危险因素。     

Prevalence of hepatitis B and C in the maternity department of a Greek district hospital.

OBJECTIVE: To define the prevalence of infection with hepatitis B virus (HBV) and hepatitis C virus (HBC), and the modifications observed during the last 8 years, amongst parturients who gave birth in our department. DESIGN: This was a retrospective study. PATIENTS: The 5497 parturients who gave birth in our department between October 1994 and September 2002. RESULTS: On average, 3.87% (213) of the pregnant women tested positive for hepatitis B surface antigen; 2.90% amongst pregnant Greek women and 4.67% amongst pregnant immigrant women. Among all pregnant women, 0.80% (44) tested positive for antibodies against HCV; 0.16% amongst Greek women and 1.33% amongst immigrant women. CONCLUSIONS: HBV prevalence in pregnant women did not seem to be affected by the increase of immigrants in our obstetric population over the course of time. HCV prevalence in the pregnant women, however, did seem to follow the increase of immigrants in our obstetric population. Economic and security issues unfortunately deprive some neonates, born to mothers with HBV infection, from the use of hepatitis B immunoglobulin.     

Efficacy of Antiviral Therapy in HBsAg-Positive Pregnant Women to Reduce Mother-to-Infant Transmission of Hepatitis B Virus

Background and Objectives

Hepatitis B is a major health concern in Asia. Chronic hepatitis B virus (HBV) infection may cause hepatic cirrhosis and liver cancer. HBV is transmitted horizontally through blood and blood products and vertically from mother to infant. Perinatal infection is the main route of transmission in regions with high prevalence of hepatitis B surface antigen (HbsAg) carriage, and perinatal transmission leads to high rates of chronic infection. Therefore, it is important to prevent mother-to-child transmission (MTCT) of HBV1. The present study aims at comparing the use of antivirals (lamivudine vs tenofovir) in reducing MTCT.

Materials and Methods

A total of 60 HbsAg-positive pregnant women were enrolled in the prospective study to test the efficacy of antiviral (lamivudine vs tenofovir—category B drug) to reduce mother-to-child transmission and monitor hepatitis B viral status in infant. HbsAg-positive pregnant women aged 18–43 years at gestational age between 28 and 32 weeks were followed up. They were tested for HBsAg, liver function test and HBeAg. In whom HbeAg was positive, HBV viral load was tested. Sixty patients with high viral load (>6 log copies/ml) were recruited in the study. Alternate patients were randomized into two groups. Group A comprised 31 subjects treated with lamivudine 100 mg daily starting from 28 to 32 weeks of gestation (third trimester) and continued to 1 month after delivery. Group B comprised 29 pregnant women who were treated with tenofovir 300 mg daily from 28 to 32 weeks of gestation and continued to 1 month post-partum. The newborn babies were given HBIG within 24 h after delivery and HBV vaccines at 0, 1 and 6 months. HBsAg infectivity was tested in the infant at 1 year after birth.

Results

Antivirals, lamivudine/tenofovir treatment in HBV carrier mothers from 28 weeks of gestation along with active and passive immunization of new born may interrupt MTCT of HBV efficiently. Tenofovir, category B drug, is more effective in preventing transmission of HBV infection to infants (p = 0.004).

     

妊娠合并乙型肝炎病毒感染孕妇胎儿窘迫发病原因分析

目的：探讨妊娠合并乙型肝炎病毒（HBV）感染孕妇胎儿窘迫的病因、预后及治疗方法。方法：对81例妊娠期HBV表面抗原（HBsAg）、HBVe抗原（HBeAg)、HBV核心抗体（HBcAb)和HBV DNA均阳性,肝功能正常的孕妇及其新生儿（研究组）,85例无肝炎病毒感染,肝功能正常的孕妇及新生儿（对照组）的临床资料、血清学检查结果、胎盘病理检查结果和胎儿预后进行分析,并对研究组中76例婴儿在出生后0、1、6月龄时分别注射酵母菌重组乙型肝炎疫苗10μg,24月龄时检测婴儿HBV表面抗体（HBsAb),以评价母婴HBV阻断效果。结果：（1）研究组胎儿窘迫的发生率为38．3％,对照组为16．5％,两组比较差异有显著性（P＜0．05）。（2）HBV感染胎盘可导致绒毛膜血管病。（3胎儿窘迫者,24月龄时母婴阻断率为78．6％,无胎儿窘迫者母婴HBV阻断率为91．7％,两 者比较,差异有显著性（P＜0．05）。结论：妊娠合并HBV感染,可引起胎盘绒毛膜血管病,致使胎盘功能下降,临床表现为胎儿窘迫、进而导致HBV母婴阻断失败。