广东省妇幼保健院门诊孕妇HBV感染状况分析
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摘要
目的了解广东省妇幼保健院产科门诊孕妇乙型肝炎病毒(HBV)感染情况,为围产期干预管理,预防乙肝母婴传播提供参考。方法回顾性分析2015年1月1日至2016年12月31日期间广东省妇幼保健院产科门诊孕妇首次进行血清乙肝五项及HBV DNA检测的实验室结果。描述孕妇乙肝感染情况及其年龄特征,分析乙肝病毒e抗原(HBeAg)与乙肝病毒载量的关系。结果孕妇共计13 093人,检出乙肝表面抗原(HBsAg)阳性孕妇1 424例。HBsAg携带率为10.88%(1 424/13 093),携带率随年龄的增长而升高,趋势有统计学意义(Z=2.70,P<0.05),其中≤24岁组孕妇携带率最低,为9.64%(182/1 888)。>34岁组孕妇携带率最高,为11.85%(228/1 924)。26.69%(380/1 424)的乙肝感染孕妇同时合并HBeAg阳性。比较发现,HBeAg阳性乙肝感染孕妇中HBV DNA>10~6IU/mL的孕妇比例为60.56%(43/71),高于HBeAg阴性乙肝感染孕妇中的6.04%(11/182),差异有统计学意义(χ~2=90.42,P<0.05)。结论广东省妇幼保健院门诊孕妇人群中HBsAg携带率较高。HBeAg阳性乙肝感染孕妇存在较高的母婴传播风险,是预防乙肝宫内感染的重点人群。围产期应密切监测HBV DNA载量,及时提供抗病毒治疗,预防乙肝宫内感染。
Objective To investigate the HBV infection status of pregnant woman in outpatient department of obstetrics in Guangdong Women and Children Hospital,so as to provide reference for management of perinatal intervention and prevention of mother-to-child transmission.Methods Retrospective analysis was conducted on laboratory results of serum hepatitis B and HBV DNA testing taken by pregnant women for the first time in outpatient department of obstetrics in Guangdong Women and Children Hospital.HBV infection status and characteristics of age were described,and the relationship between HBeAg and viral load of HBV was analyzed.Results There were 13 093 pregnant women in the study,and 1 424 pregnant woman were detected with HBsAg-positive,with carrier rate of 10.88%(1 424/13 093).The HBsAg carrier rate increased with age,and the trend was statically significant(Z=2.70,P<0.05).The lowest carrier rate was 9.64%(182/1 888)for women aged 24 years or under.The highest rate was 11.85%(228/1 924)among pregnant women over 34 years.There were 26.69%(380/1 424)HBV infected pregnant women combined with HBeAg-positive.The proportion of cases with HBV DNA>10~6 IU/mL among HBV infected women with HBeAg-positive was 60.56%(43/71),which was higher than 6.04%(11/182)among HBV infected women with HBeAg-negative with statistical significance(χ~2=90.42,P <0.05).Conclusion In outpatient pregnant women in Guangdong Women and Children Hospital,the carrier rate of HBsAg is high.HBV infected pregnant women with HBeAg-positive have a higher risk of mother-to-child transmission,and they are the key population of prevention of HBV intrauterine infection.During perinatal period,HBV DNA load should be closely monitored and antiviral treatment should be provided timely to prevent HBV intrauterine infection.
Objective To investigate the HBV infection status of pregnant woman in outpatient department of obstetrics in Guangdong Women and Children Hospital,so as to provide reference for management of perinatal intervention and prevention of mother-to-child transmission.Methods Retrospective analysis was conducted on laboratory results of serum hepatitis B and HBV DNA testing taken by pregnant women for the first time in outpatient department of obstetrics in Guangdong Women and Children Hospital.HBV infection status and characteristics of age were described,and the relationship between HBeAg and viral load of HBV was analyzed.Results There were 13 093 pregnant women in the study,and 1 424 pregnant woman were detected with HBsAg-positive,with carrier rate of 10.88%(1 424/13 093).The HBsAg carrier rate increased with age,and the trend was statically significant(Z=2.70,P<0.05).The lowest carrier rate was 9.64%(182/1 888)for women aged 24 years or under.The highest rate was 11.85%(228/1 924)among pregnant women over 34 years.There were 26.69%(380/1 424)HBV infected pregnant women combined with HBeAg-positive.The proportion of cases with HBV DNA>10~6 IU/mL among HBV infected women with HBeAg-positive was 60.56%(43/71),which was higher than 6.04%(11/182)among HBV infected women with HBeAg-negative with statistical significance(χ~2=90.42,P <0.05).Conclusion In outpatient pregnant women in Guangdong Women and Children Hospital,the carrier rate of HBsAg is high.HBV infected pregnant women with HBeAg-positive have a higher risk of mother-to-child transmission,and they are the key population of prevention of HBV intrauterine infection.During perinatal period,HBV DNA load should be closely monitored and antiviral treatment should be provided timely to prevent HBV intrauterine infection.
引文
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[9]血清HBsAg、HBeAg和抗-HBc定量检测在慢性乙型肝炎患者抗病毒治疗中的临床意义[J].中国病毒病杂志,2016,(2):146-153.
[2]Liu J,Zhang S,Liu M,et al.Maternal pre-pregnancy infection with hepatitis B virus and the risk of preterm birth:apopulation-based cohort study[J].Lancet Glob Health,2017,5(6):e624-e632.
[3]Tan J,Liu X,Mao X,et al.HBsAg positivity during pregnancy and adverse maternal outcomes:a retrospective cohort analysis[J].J Viral Hepat,2016,23(10):812-819.
[4]王贵强,王福生,成军,等.慢性乙型肝炎防治指南(2015年更新版)[J].临床肝胆病杂志,2015,31(12):1941-1960.
[5]Cui F,Shen L,Li L,et al.Prevention of chronic hepatitis B after 3 decades of escalating vaccination policy,China[J].Emerg Infect Dis,2017,23(5):765-772.
[6]杜二球,段学英,高霞,等.562例HBsAg阳性孕妇HBV宫内感染及产后随访分析[J].中国妇幼健康研究,2017,28(02):178-180.
[7]Kang W,Li Q,Shen L,et al.Risk factors related to the failure of prevention of hepatitis B virus Mother-toChild transmission in Yunnan,China[J].Vaccine,2017,35(4):605-609.
[8]Ozaras R,Balkan I,Yemisen M,et al.Elimination of mother-to-child transmission of hepatitis B[J].Lancet Infect Dis,2016,16(1):20-21.
[9]血清HBsAg、HBeAg和抗-HBc定量检测在慢性乙型肝炎患者抗病毒治疗中的临床意义[J].中国病毒病杂志,2016,(2):146-153.