西藏阿里地区孕产妇及婴幼儿人群乙肝病毒感染状况研究
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摘要
目的研究高高原地区孕产妇和婴幼儿人群中乙肝的感染状况,以期制定有效的防控和治疗方案。方法研究对象为2016年1月1日—2018年3月31日于阿里地区人民医院及所辖七县卫生服务中心就诊的所有孕产妇,共计832名,平均年龄为(28±2.8)岁,以及该院新生儿科和儿科就诊的所有婴幼儿人群(0月龄～3周岁),共计1 086名,平均年龄为(1.6±0.8)岁,其中男性患儿为519名,女性患儿为567名,男女性别比为0.92∶1,分别研究孕产妇和婴幼儿人群中乙型肝炎病毒感染及乙肝免疫保护状况的年龄、地域和性别分布。结果阿里地区孕产妇人群的HBsAg阳性率为17.19%(143/832)。不同年龄段孕产妇的HBsAg阳性率差异无统计学意义(P>0.05)。城镇和农牧区孕产妇的HBsAg阳性率分别为13.66%(56/410)和20.62%(87/422),差异有统计学意义(P<0.05)。143名HBsAg阳性孕产妇中,HBsAg、HBeAg、HBcAb阳性孕产妇占46.85%(67/143)。3岁以下婴幼儿人群HBsAg总体阳性率为7.73%(84/1 086),不同年龄段婴幼儿的HBsAg阳性率差异有统计学意义(P<0.05)。男性婴幼儿和女性婴幼儿的HBsAg阳性率分别为5.20%(27/519)和10.05%(57/567),差异有统计学意义(P<0.05)。农牧区和城镇区婴幼儿HBsAg阳性率分别为9.16%(50/546)和6.30%(34/540),差异无统计学意义(P>0.05)。孕产妇总体乙肝表面抗体(HBsAb)阳性率为32.51%(224/689),婴幼儿总体HBsAb阳性率为40.52%(406/1 002)。结论阿里地区孕产妇及婴幼儿人群HBsAg阳性率高,需进一步加强孕前检查及母婴阻断干预措施,加强对乙肝患者及携带者的随访管理。
Objective To investigate the status of hepatitis B virus(HBV) infection in pregnant women and infants in high altitude areas, in order to develop effective prevention and treatment programs.Methods A total of 832 pregnant women and 1 086 infants(under 3 years old) were included in this investigation in the People's Hospital of Ali from January 1, 2016 to March 31, 2018. The average age of these pregnant women was(28±2.8)years and the average age of these infants was(1.6±0.8)years. Among all the infants, 519 infants were male and 567 were female. The male to female sex ratio was 0.92∶1. The age, region and gender distribution of HBV infection and immune protection to HBV were studied among the pregnant women and infants.Results The over total positive rate of HBsAg(hepatitis B surface antigen) in the pregnant women was 17.19%(143/832) in Ali area. There was no significant difference in the positive rate of HBsAg among different age groups of the pregnant women(P>0.05). The positive rates of HBsAg in the pregnant women from urban and rural areas were 13.66%(56/410) and 20.62%(87/422), respectively, and there was a statistically significant difference(P<0.05). Among the 143 cases of HbsAg positive pregnant women, HBsAg, HBeAg(hepatitis B e antigen), and HBcAb(hepatitis B core antibody) positive pregnant women accounted for 46.85%(67/143). The overall positive rate of HBsAg in the infants aged under 3 years was 7.73%(84/1 086). The positive rates of HBsAg in infants of different age groups showed statistically significant difference(P<0.05). The positive rates of HBsAg in the male infants and female infants were 5.20%(27/519) and 10.05%(57/567),respectively, and there was a statistically significant difference(P<0.05). The positive rates of HBsAg in the infants from urbanand rural areas were 9.16%(50/546) and 6.30%(34/540), respectively, and there was no statistically significant difference(P>0.05). The overall positive rate of HBsAb(hepatitis B surface antibody) was 32.51%(224/689) in the pregnant women, and the overall positive rate of HBsAb in the infants was 40.52%(406/1 002).Conclusions The positive rates of HBsAg in pregnant women and infants in Ali area are high. It is necessary to further strengthen the pre-pregnancy examination and intervention measures for blocking the mother-to-child transmission of HBV, and to strengthen the follow-up management of hepatitis B patients and carriers.
Objective To investigate the status of hepatitis B virus(HBV) infection in pregnant women and infants in high altitude areas, in order to develop effective prevention and treatment programs.Methods A total of 832 pregnant women and 1 086 infants(under 3 years old) were included in this investigation in the People's Hospital of Ali from January 1, 2016 to March 31, 2018. The average age of these pregnant women was(28±2.8)years and the average age of these infants was(1.6±0.8)years. Among all the infants, 519 infants were male and 567 were female. The male to female sex ratio was 0.92∶1. The age, region and gender distribution of HBV infection and immune protection to HBV were studied among the pregnant women and infants.Results The over total positive rate of HBsAg(hepatitis B surface antigen) in the pregnant women was 17.19%(143/832) in Ali area. There was no significant difference in the positive rate of HBsAg among different age groups of the pregnant women(P>0.05). The positive rates of HBsAg in the pregnant women from urban and rural areas were 13.66%(56/410) and 20.62%(87/422), respectively, and there was a statistically significant difference(P<0.05). Among the 143 cases of HbsAg positive pregnant women, HBsAg, HBeAg(hepatitis B e antigen), and HBcAb(hepatitis B core antibody) positive pregnant women accounted for 46.85%(67/143). The overall positive rate of HBsAg in the infants aged under 3 years was 7.73%(84/1 086). The positive rates of HBsAg in infants of different age groups showed statistically significant difference(P<0.05). The positive rates of HBsAg in the male infants and female infants were 5.20%(27/519) and 10.05%(57/567),respectively, and there was a statistically significant difference(P<0.05). The positive rates of HBsAg in the infants from urbanand rural areas were 9.16%(50/546) and 6.30%(34/540), respectively, and there was no statistically significant difference(P>0.05). The overall positive rate of HBsAb(hepatitis B surface antibody) was 32.51%(224/689) in the pregnant women, and the overall positive rate of HBsAb in the infants was 40.52%(406/1 002).Conclusions The positive rates of HBsAg in pregnant women and infants in Ali area are high. It is necessary to further strengthen the pre-pregnancy examination and intervention measures for blocking the mother-to-child transmission of HBV, and to strengthen the follow-up management of hepatitis B patients and carriers.
引文
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[13]陆瑾,刘捷宸,姜铭波,等.上海市黄浦区孕产妇乙肝表面抗原携带率及新生儿免疫接种情况分析[J].上海预防医学,2017,29(3):197-199,213.
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[15]慢性乙型肝炎防治指南2010年更新版中华实验和临床感染病杂志(电子版)2011(1):79-100.
[2]LEUNG N.Chronic hepatitis B in Asian women of childbearing age[J].Hepatology International,2009,3(S1):24-31.
[3]PARK J S,PAN C.Current recommendations of managing HBVinfection in preconception or pregnancy[J].Front Med,2014,8(2):158-165.
[4]ZHANG L,GUI X E,WANG B,et al.A study of immunoprophylaxis failure and risk factors of hepatitis B virus mother-to-infant transmission[J].European Journal of Pediatrics,2014,173(9):1161-1168.
[5]DUFFELL E F,VAN DE LAAR M J W,AMATO-GAUCI A J.Enhanced surveillance of hepatitis B in the EU,2006-2012[J].Journal of Viral Hepatitis,2015,22(7):581-589.
[6]YAO J L.Perinatal transmission of hepatitis B virus infection and vaccination in China[M].1996,38 Suppl 2(supplement 2):S37.
[7]BIAN T,YAN H,SHEN L,et al.Change in hepatitis B virus large surface antigen variant prevalence 13 years after implementation of a universal vaccination program in China[J].Journal of Virology,2013,87(22):12196-12206.
[8]孙校金,崔富强,王富珍,等.贫困地区孕产妇乙型肝炎病毒表面抗原筛查服务利用现状及影响因素研究[J].中国疫苗和免疫,2011,17(5):408-411,435.
[9]FRENETTE C T,GISH R G.The new epidemiology of hepatitis B in the United States[J].Current Hepatitis Reports,2009,8(1):3-9.
[10]BELOPOLSKAYA M,AVRUTIN V,FIRSOV S,et al.HBsAg level and hepatitis B viral load correlation with focus on pregnancy[J].Ann Gastroenterol,2015,28(3):379-384.
[11]LEE L Y,AW M,RAUFF M,et al.Hepatitis B immunoprophylaxis failure and the presence of hepatitis B surface gene mutants in the affected children[J].Journal of Medical Virology,2015,87(8):1344-1350.
[12]鲍雪琴.深圳市孕妇乙肝感染状况分析及乙肝母婴阻断效果评价[D].郑州:郑州大学,2017.
[13]陆瑾,刘捷宸,姜铭波,等.上海市黄浦区孕产妇乙肝表面抗原携带率及新生儿免疫接种情况分析[J].上海预防医学,2017,29(3):197-199,213.
[14]刘云花.长沙市1200例婴幼儿乙肝标志物以及免疫状态调查分析[J].中国医学工程,2015,23(11):116-117.
[15]慢性乙型肝炎防治指南2010年更新版中华实验和临床感染病杂志(电子版)2011(1):79-100.