562例HBsAg阳性孕妇HBV宫内感染及产后随访分析

目的 探讨HBV母婴垂直传播特点.方法 选取湖北医药学院附属人民医院单胎妊娠、HBV感染的562例孕妇及其新生儿为研究对象,分析HBV宫内感染及产后婴幼儿HBV感染情况.结果 母亲乙肝标志物HBsAg、HBeAg、HBcAb阳性348例,宫内感染35例,宫内感染率10.06%;母亲乙肝标志物HBsAg、HBeAb、HBcAb阳性共214例,宫内感染5例,宫内感染率2.34%.对所有宫内感染病例40例随访,37例转阴,余未感染病例150例随访未发现HBV感染.孕妇乙肝大三阳组与小三阳组宫内感染率存在明显差异(χ2=11.95,P=0.001<0.05);孕妇HBeAg阳性前S1抗原阳性和前S1抗原阴性宫内感染率存在明显差异(χ2=13.74,P<0.05);孕妇HBV-DNA病毒复制量大于106与小于106宫内感染率存在明显差异(χ2=4.29,P<0.05).结论 孕妇HBV病毒复制量高是导致宫内感染的重要因素.产后及时主被动免疫联合免疫治疗是阻断母婴垂直传播的关键.

HBV intrauterine infection and postpartum follow-up in 562 cases of HBV positive pregnant women

Objective To investigate the HBV characteristics of vertical transmission. Methods Totally 562 cases of singleton pregnancy with HBV infection and their neonates were selected in Renmin Hospital of Hubei University of Medical and analyzed for HBV intrauterine infection and HBV infection in infants. Results There were 348 cases with positive HBsAg, HBeAg and HBcAb in maternal HBV markers, and 35 cases of intrauterine infection with rate of 10. 06%. There were 214 cases whose HBV markers of HBsAg, HBeAb and HBcAb were positive, and 5 neonates were infected with intrauterine infection rate of 2. 34%. Thirty-seven of 40 neonates of intrauterine infection became negative. HBV was not found in follow-up among 150 neonates who were not infected. There was significant difference between group of positive HBsAg,HBeAg and HBcAb and group of positive HBsAg,HBcAb and HAcAb(χ2 =11. 95,P =0. 001 <0. 05). The difference between HBV positive markers of pre-S1 protein and HBV negative markers of pre-S1 protein was significant (χ2 =13. 74,P<0. 05). There was remarkable difference between cases with HBV-DNA virus replication of greater than 1106 and that of less than 1106 (χ2 =4. 29,P<0. 05). Conclusion High viral replication of HBV is an important factor in intrauterine infection for neonates. The key to prevent vertical transmission is the timely combination of active and passive immunization therapy after birth.