不同分娩方式与乙型肝炎病毒母婴垂直传播关系的研究——附290例分析

目的:探讨不同分娩方式对HBV母婴垂直传播的影响.方法:选择290例HBsAg阳性孕妇及其新生儿,按分娩方式不同分为经阴道分娩(阴道产)组168例、剖宫产组122例,分别于孕妇入院时及其新生儿出生24 h内注射乙型病毒性肝炎(乙肝)免疫球蛋白及乙肝疫苗前抽取外周静脉血,检测血清乙肝病毒标志物、HBV DNA水平,以新生儿出生后24 h内血清HBsAg阳性和(或)HBV DNA 阳性(≥106 copies/L)作为HBV母婴垂直传播的诊断标准.分析HBV DNA水平与分娩方式与HBV母婴垂直传播的关系.结果:290例HBsAg阳性孕妇及其新生儿中,发生HBV母婴垂直传播26例(9.0%),其中HBV DNA≤106、107～1011、>1011 copies/L者的HBV母婴垂直传播发生率分别为3.8%、14%、44%.随着HBV DNA水平的升高,HBV母婴垂直传播发生率增加(P均<0.01).阴道产组的HBV母婴垂直传播发生率为10.1%(17/168),剖宫产组的HBV母婴垂直传播发生率为7.4%(9/122).两组母亲血清HBV DNA≤1011 copies/L时HBV垂直传播发生率比较差异无统计学意义(P均>0.05),母亲血清HBV DNA>1011 copies/L时阴道产组HBV垂直传播发生率明显高于剖宫产组(P<0.05).结论:HBV母婴垂直传播与分娩方式有关,当孕妇血清HBV DNA >1011copies/L时建议采用剖宫产.

Research about the efficacy of delivery mode on maternal-infant transmission of hepatitis B virus

Objective:To investigate the efficacy of delivery mode on maternal-infant transmission of hepatitis B virus. Methods:According to delivery mode,290 cases of HBsAg positive mothers were divided into vaginal delivery group(n=168) and caesarean section group(n=122).Venous blood was drawn from mothers and their neonates,and HBV M was detected by enzyme linked immunoadorbent assay(ELISA).The data were compared the difference of infectious rate among the three groups.Results:In 290 patients with HBeAg-positive pregnant women and their newborns,the occurrence of HBV vertical transmission in 26 cases(9.0%)of HBV DNA≤106,107 ~ 1011 and > 1011 copies/L of HBV vertical transmission rates were 3.8%,14%,44% respectively.With increasing HBV DNA levels of HBV vertical transmission increased incidence(P<0.01).Vaginal delivery group HBV vertical transmission rate was 10.1%(17/168),and the cesarean section group HBV vertical transmission rate was 7.4%(9/122).Two sets of maternal serum HBV DNA≤1011 copies/L HBV vertical transmission rate were no significant difference(P>0.05),but which was significantly higher incidence of maternal serum HBV DNA> 1011 copies/L HBV vertical transmission of vaginal delivery group cesarean section group(P<0.05).Conclusion:Caesarean section could decrease the maternal-infant transmission of hepatitis B virus if the HBV DNA is more than 1011copies/L.