陕西地区孕妇HBV感染现状与母婴传播的危险因素

目的调查陕西省孕妇HBV感染率并筛选母婴传播高危人群。方法自2010年-2015年连续调查了陕西省18家医院13 451名孕妇HBV感染情况,对所有HBs Ag阳性孕妇所生婴儿进行联合免疫,采用单因素及多因素logistic回归分析母婴传播的高危因素。计量资料组间比较采用t检验或Mann-Whitney U检验。计数资料多组间比较采用χ^2检验。结果陕西省孕妇HBsAg流行率为7. 07%,陕南地区高达9. 40%。HBV母婴传播率为5. 21%,单因素分析显示母亲HBsAg滴度、HBeAg滴度、HBeAg阳性及HBV DNA载量与婴儿HBV感染相关,多因素分析显示母亲HBV DNA载量是母婴传播的独立危险因素(相对危险度:1. 586,95%可信区间:1. 020~2. 465,P=0. 041)。发生母婴传播的HBV感染孕妇中,84. 62%为HBeAg阳性且HBV DNA> 10^6IU/ml;发生母婴传播的婴儿15. 38%来自于HBeAg阴性的HBV感染孕妇。HBeAg阳性且HBV DNA> 10~6IU/ml的孕妇中,婴儿发生母婴传播的相对危险度为1. 210(1. 129~1. 297);而HBeAg阴性,但HBV DNA> 2×10^3IU/ml且HBsAg> 10^4IU/ml的孕妇中,婴儿发生母婴传播的相对危险度为26. 062(2. 633~258. 024)。结论陕西省孕妇HBV感染率仍高,HBeAg阳性且高病毒载量孕妇发生母婴传播风险较高;HBeAg阴性母亲所生婴儿HBV感染率虽然低,但当母亲HBV DNA> 2×10^3IU/ml且HBsAg> 104IU/ml时仍有较高母婴传播的风险。

Current status of hepatitis B virus infection among pregnant women in Shaanxi Province,China and risk factors for mother-to-infant transmission

Objective To investigate the hepatitis B virus( HBV) infection rate among pregnant women in Shaanxi Province,China and the high-risk population of mother-to-infant transmission( MTIT). Methods A survey was performed for 13 451 pregnant women in 18 hospitals in Shaanxi Province to investigate the status of HBV infection,and combined immunization was performed for the infants born to HBsAg-positive women. Univariate and multivariate logistic regression analyses were used to investigate the risk factors for MTIT. The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups. Results The prevalence rate of HBsAg was 7. 07% among the pregnant women in Shaanxi Province,and the rate reached as high as 9. 40% in southern Shaanxi. The MTIT rate of HBV was 5. 21%. The univariate analysis showed that HBsAg titer,HBeAg titer,positive HBeAg,and HBV DNA load in mothers were associated with HBV infection in infants,and the multivariate analysis showed that HBV DNA load in mothers is an independent risk factor for MTIT( relative risk = 1. 586,95% confidence interval: 1. 020-2. 465,P = 0. 041). Among the pregnant women with HBV infection and MTIT,84. 62% had positive HBe Ag and an HBV DNA load of > 10~6 IU/ml;among the infants with MTIT,15. 38% were the infants born to the HBe Ag-negative pregnant women. For the pregnant women with positive HBe Ag and HBV DNA > 10~6 IU/ml,the relative risk of MTIT in infants was 1. 210( 1. 129-1. 297);for the pregnant women with negative HBe Ag,HBV DNA > 2 × 10~3 IU/ml,and HBs Ag > 104 IU/ml,the relative risk of MTIT in infants was 26. 062( 2. 633-258. 024). Conclusion There is a high HBV infection rate among pregnant women in Shaanxi Province. Pregnant women with positive HBeAg and a high HBV DNA load have a high risk of MTIT. Although the infants born to HBeAg-negative mothers have a low HBV infection rate,there is still a high risk of MTIT when the mother has an HBV DNA load of > 2 × 10~3 IU/ml and an HBsAg level of > 10~4 IU/ml.