乙型肝炎病毒宫内传播的多因素分析

目的探讨不同乙肝类型的宫内传播结果,为更好地阻断HBV宫内传播提供依据。方法对HBsAg阳性的产妇及其婴儿分别检测乙肝病毒血清学标志物及HBV-DNA。结果①57例新生儿有7例发生宫内HBV感染,感染率为12.28%。②脐血与外周静脉血比较,脐血的假阳性率为20%,其敏感性及阳性预测值分别为100%和80%。③9-18月个后追踪49例研究组新生儿,HBsAg持续阳性者12例,阳性率为24.49%;HBV-DNA持续阳性者4例,阳性率为8.16%;HBsAb转阳3例,转阳率为6.12%。④HBeAg或HBV-DNA阳性产妇,其婴儿感染率分别为86.67%和100%。结论①合并乙型肝炎e抗原阳性、HBV-DNA阳性的孕妇易发生宫内传播;②新生儿脐血检测可以作为宫内传播的筛查指标。

Multilateral analysis of prognostic factors on HBV intrauterine infection

Objective To investigate the HBV infectious rate of HBV carrier mothers and later of their infants.Methods HBV carrier mothers and later their infants.57 mothers and their 57 infants were followed for 9-18 months.Their serum was investigated.HBVM was measured by ECL methods.HBV-DNA was detected by Q-PCR.Results Seven cases of 57 newborn infants were observed infected.The rate of infection was 12.28%.Comparing with peripheral venous blood sample,the sensitivity and positive predictive value of HBV detected in cords was 100.00%,80.00%respectively.9-18 months later,12 cases of the infants became HBV chronic carriers.The fetal infectious rate in mothers with HBeAg or HBV-DNA positive was 86.67%,100%,respectively,which was significantly higher than that in mothers with HBeAg or HBV-DNA negative(P<0.01).Conclusion HBeAg or HBV-DNA positive in mothers is one of the risk factors of intrauterine infection.Detection of HBV-DNA in cord blood is a sensitive index for diagnosing fetal infection,however,detection of peripheral venous blood is with the significance of making correct diagnosis.