孕妇乙型肝炎病毒携带状态与母婴传播的研究

目的 :探讨孕妇乙型肝炎 (乙肝 )病毒 (HBV)携带状态与母婴传播的关系。方法 :用荧光定量PCR法检测HBV表面抗原 (HBsAg)阳性孕妇血清中HBV脱氧核糖核酸(HBVDNA)及脐血HBVDNA ,婴儿出生后 1 2h内及第 1 4天注射乙肝免疫球蛋白 ,并按0、1、6的程序全程接种乙肝疫苗 ,进行前瞻性随访研究 ,分别于婴儿 7月及 1 2月时随访 ,检测HBVDNA及乙肝血清标志物 ,婴儿 7月时未感染乙肝但抗 HBs阴性者加强注射乙肝疫苗 5μg。 结果 :HBsAg、HBeAg及抗 HBc阳性孕妇的新生儿脐血HBVDNA阳性率为1 8.37% (9/ 4 9) ;HBsAg及HBeAg双阳性者为 1 2 .50 % (2 / 1 6) ;HBsAg及抗 HBc阳性者为1 2 .50 % (3/ 2 4 ) ;HBsAg,抗 HBe和抗 HBc阳性者为 1 .37% (1 / 73) ;脐血HBVDNA阳性的新生儿均生于HBVDNA阳性的母亲 ,阳性率为 1 8.52 % (1 5/ 81 ) ,不同HBV携带状态的脐血阳性率有统计学差异。总母婴传播率为 9.78%。结论 :孕妇HBV携带状态与母婴传播有关 ,孕妇血清HBeAg阳性或HBVDNA含量高是母婴传播的重要因素之一 ,孕妇血清HBVDNA阴性者母婴垂直传播的风险极小。在新生儿、婴儿接受被动及主动全程联合免疫的条件下 ,产时、产后HBV的母婴传播可以预防

Study on HBV carrier status and maternal-infant transmission

Objective:To explore the relationship between the HBV car rier status and maternal-infant transmission. Methods: HBV-makers were tested by enzyme l inked immunosorbent assay (ELISA). HBV deoxyribonucleic acid (HBV DNA) of matern al and umbilical blood was done by fluorescence quantitative polymerse chain rea ction (FQ-PCR) technique. All infants received HBV specific immunoglobin(HBIG ) within 12 hours and at 14th days after birth. The hepatitis B recombinant vacc ine was given within 24 hours after birth and at 1 and 6 months of age. Infants we re then followed up at 7 and 12 months of age and tested for HBV-makers and HBV DNA. Uninfected infants with negative hepatitis B surface antibody were given r e peated vaccinations. Results: The positive rate of umbilical blood HBV DNA was 18. 37%(9/49) for newborns whose mothers were HBsAg, HBeAg, anti-HBc positive; 12. 50%(2/16) for HBsAg, HBeAg positve;12.50% (3/24) for HBsAg, anti-HBc positiv e ;only 1.37%(1/73)for HBsAg, anti-HBe, anti-HBc positive. All babies whose um bilical blood HBV DNA was positive were born to the women who were positive for HBV DNA18.52%(15/81). There were significant differences among different HBV ca rrier status. The overall vertical transmission rate was 9.78%(9/92). Conclusions:The prevalence of HBV infection of the infants is associated with the HBV carrier status of the mothers.Serum HBeAg positive or h igher HBV DNA load in pregant women is one of the important factors for vertical t ransmission.The risk of vertical transmission is less in women whose HBV DNA was negative.With appropriate immunoprophylaxis, Infections occurring during or di rectly after delivery can be prevented.