孕妇乙型肝炎病毒宫内感染相关危险因素研究

目的 探讨厦门市孕妇乙型肝炎病毒（hepatitis B virus，HBV）感染情况和HBV宫内感染的影响因素。方法 在1 064名孕妇第一次到医院建立孕产妇保健卡时进行问卷调查并检测其血清乙肝标志物，根据检测结果选择外周血乙型肝炎表面抗原（hepatitis B surface antigen，HBsAg）阳性的产妇179例随访至其分娩，并采集其分娩时的脐血和胎盘组织。对脐血进行HBsAg和HBV DNA的检测，对胎盘组织进行HBsAg的检测。采用χ2检验和非条件Logistic回归分析相关因素与HBV宫内感染的关系。结果 被调查的1 064名孕妇中，HBsAg阳性的孕妇共179名，感染率为16.8%。对179名HBsAg阳性的孕妇的脐血进行检测发现，发生HBV宫内感染的孕妇共34名，感染率为19.0%。孕妇HBV宫内感染的危险因素为胎盘HBsAg阳性、孕妇血清乙型肝炎E抗原（hepatitis Be antigen，HBeAg）阳性、孕前超重，OR分别为5.123（95%CI:1.422~18.413）、4.619（95%CI:1.225~17.534）、3.343（95%CI:1.233~9.092）。结论 对于HBsAg和HBeAg双阳性的超重/肥胖孕妇，其新生儿可能发生HBV宫内感染，应加强自身防护措施，合理规避HBV宫内感染风险。

Study on the risk factors for intrauterine infection of hepatitis B virus among pregnant women

Objective To investigate the prevalence of hepatitis B virus (HBV) infection in pregnant women and the risk factors for Intrauterine infection of HBV among pregnant women in Xiamen. Methods Total 1 064 pregnant women were included in this study. A questionnaire was performed to collect the general information of the subjects and HBV infection status was tested on the first day when they came to the hospital. Then HBsAg positive pregnant women were selected and followed until delivery. We collected their cord blood and placenta tissue when they delivery. HBsAg and HBV DNA in cord blood and HBsAg in placental tissue were detected. Chi-square test and the non-conditional Logistic regression analysis were conducted to investigate the correlation between HBV intrauterine infection and risk factors. Results 179 out of the 1 064 pregnant women were HBsAg positive. The infection rate was 16.8%. 34 out of 179 HBsAg positive pregnant women were found intrauterine transmission with a rate of 19.0%. The risk factors for the occurrence of HBV intrauterine transmission were placenta HBsAg positive (OR=5.123,95% CI:1.422-18.413), mothers with hepatitis B e antigen(HBeAg) positive (OR=4.619,95% CI:1.225-17.534) and overweight(OR=3.343,95% CI:1.233-9.092), respectively. Conclusions Placenta HBsAg positive, mothers with HBeAg positive and overweight are independent risk factors for the occurrence of HBV intrauterine transmission.