武汉市乙肝母婴传播阻断措施及效果评价研究
|
摘要
研究目的
探讨影响乙肝母婴传播阻断干预措施选择的因素及主要干预措施的实质效果；对不同阻断措施的干预效果进行经济学评价，为选取最佳干预措施预防乙肝母婴传播提供科学依据。
研究方法
抽取武汉市2004年后住院分娩的、接受过系统产前检查的HBsAg阳性孕产妇及其婴儿进行回顾性现场调查研究和跟踪随访；调查方式为入户面对面问卷调查和一对一电话访谈。所有资料使用Spss10．0进行描述性分析、t检验、χ~2检验、非参数假设检验、单因素非条件logistic回归和多因素非条件logistic回归等统计学分析。
研究结果
1、阻断措施及效果：
本研究中孕产妇HBsAg阳性率为8．67％。323例调查对象中232人(71．83％)孕期注射了HBIG，其中90．00％以上首次注射HBIG时间在孕晚期，80．00％以上注射了3次；注射HBIG的婴儿有293人(90．71％)，其中276人(94．20％)注射1次。258人(79．88％)分娩方式为剖宫产，其中29．84％因乙肝因素剖宫产；153名(47．37％)婴儿人工喂养，其中81．70％因乙肝因素人工喂养。HBsAg阳性孕产妇胎膜早破的发生率、剖宫产率和人工喂养率均高于正常组孕产妇，差异有统计学意义(P＜0．05)。
323对调查的母子中，仅孕产妇在孕期注射过乙肝免疫球蛋白(HBIG)，23对(7．12％)；仅婴儿在出生后注射过HBIG(主被动免疫)，84对(26．00％)；孕产妇及其婴儿均注射过HBIG(母婴联合免疫)，209对(64．71％)；孕产妇及其婴儿均没有注射过HBIG，7对(2．17％)。
阻断后宫内感染22人(6．81％)，全程接种疫苗后，10人转阴，其中3人有抗体，7人全阴。婴儿慢性感染者15人(4．64％)，其中10人为宫内感染，3人后期感染。婴儿6个月后乙肝标志物检测，154人有抗体(47．68％)。
2、HBeAg与乙肝母婴传播：
HBsAg阳性合并乙肝e抗原(HBeAg)阳性孕产妇63人(19．51％)。双阳组剖宫产率(90．48％)高于单阳组(77．31％)，差异有统计学意义(χ~2=5．4709，P=0．00193)；因乙肝因素剖宫产的比例双阳组(63．16％)也明显高于单阳组(20．40％)，差异有统计学意义(χ~2=38．7788，P＜0．0001)。单阳组母乳喂养比例较高(61．54％)，双阳组则多为人工喂养(84．13％)，两组喂养方式差异有统计学意义(χ~2=42．4181，P＜0．0001)。人工喂养原因中因乙肝因素者，双阳组(98．11％)明显高于单阳组(73．00％)，差异有统计学意义(Fisher’Exact Test，P＜0．0001)。双阳组宫内感染率和慢性感染率为25．40％和14．29％，明显高于单阳组的2．31％，差异有统计学意义(χ~2=42．5934，16．4303，P＜0．001)。
3、影响阻断措施和效果的因素：
单因素分析中与阻断方式、次数等有关的因素有孕产妇年龄、围产期职业、文化程度、家庭人均月收入、丈夫职业和文化程度、初次产前检查时间和地点、分娩时间和地点等；与阻断效果有关的有孕产妇HBV感染状态、孕期是否注射HBIG、分娩年龄、初次产前检查时间、婴儿注射HBIG次数、母乳喂养时间和分娩年份。
多因素分析结果显示孕产妇分娩时年龄越大(OR=2．205)、孕产妇文化程度越高(OR=3．275)、家庭人均月收入越多(OR=1．693)、分娩时住院时间越短(OR=0．543)、分娩年份越早(OR=0．380)以及丈夫职业是员工类(公司职员／商业服务人员／工人／农民工)(OR=2．205)，孕产妇越趋向于选择孕期注射HBIG；婴儿注射HBIG次数越多(OR=3．873)、母乳喂养时间越长(OR=9．815)，婴儿6个月后越容易产生抗-HBs。
4、经济学分析：
减少宫内感染母婴联合阻断成本-效果比低于仅孕期阻断，减少婴儿慢性感染联合
阻断成本-效果比低于仅婴儿阻断，增加抗体保护率的成本效果联合阻断优于仅孕期阻断，更优于仅婴儿阻断。三种措施挽回的DALY及成本-效用比联合阻断措施最优，敏感性分析和增量成本-效果(效用)分析后结论未变。
研究结论
1、近年来武汉市孕产妇乙肝病毒携带率呈现整体上升趋势。
2、HBeAg阳性是影响乙肝母婴传播的重要因素，而孕产妇对其重视程度明显不足。
3、HBsAg阳性孕产妇，尤其是合并HBeAg阳性者，更趋向于剖宫产和人工喂养，而本研究中亦未见剖宫产和人工喂养与否对乙肝母婴传播阻断后效果的差异有统计学意义，认为剖宫产和人工喂养并非阻断乙肝母婴传播的必要条件。
4、乙肝母婴传播阻断措施的选择及效果不仅受个人、家庭因素影响，也与医疗环境息息相关。
5、从经济学角度综合比较，母亲孕期注射HBIG并婴儿出生后联合注射HBIG和乙肝疫苗的母婴联合阻断措施不仅在相同总成本下能够降低较多宫内感染率和婴儿慢性感染率，挽回较多DALY，还能更有效提高婴儿抗体保护率，优于其他措施，是武汉市近几年乙肝母婴传播阻断措施中最优措施，值得推荐。
Objectives
To explore the influential factors of choosing the blocking measures and the effects ofmain interventions. To evaluate the costs and effects of different blocking measures ofmother-to-child transmission of hepatitis B by the economic evaluation method, so as toselect the best intervention to prevent mother to child transmission of hepatitis B andprovide scientific evidence to the government and related departments to make reasonabledecisions.
Methods
The HBsAg-positive pregnant women and their children were taken out as studyobjects, who accepted prenatal care in district Maternal and Child Health Hospital ofWuhan City, from Jan 1st, 2004. Investigators who received strict training madeface-to-face or telephone interviews to these women with uniform questionnaires based ona voluntary and confidential principle. SPSS10.0 software was used to do data analysis,including descriptive analysis, t test. Chi-square test, nonparametric test, single factor andmulti-factor non-conditional logistic regression.
Results
1. Blocking measures and effect
The HBsAg positive rate among the pregnant women was 8.67%. 232 pregnant women (71.83%) were injected HBIG during pregnancy, and 90.00% of them began toinject in the third trimester of pregnancy. 90.00% of the pairs injected three needles. 293children were injected HBIG after birth, 94.20% of them accepted 1 needles. In the 323pregnant women, 258 (79.88%) had cesarean section, of which, 29.84% had cesareansection due to hepatitis B factors. 153 pregnant women (47.37%) developed artificialfeeding, 81.70% of which were owing to hepatitis B factors.
The incidence of premature rupture of membranes, cesarean section and artificialfeeding of HBsAg positive pregnant women were higher than those of normal pregnantwomen, with statistically significant difference (P＜0.05).
Among the 323 pairs of mothers and children, there were 23 pairs (7.12%) thatpregnant women without their children were injected HBIG during pregnancy. 84 pairs(26.00%) children alone were injected HBIG at birth and after birth (active and passiveimmunization). 209 pairs (64.71%) both pregnant women and their children were injectedHBIG (united maternal and child immunization). 7 pairs (2.17%) neither pregnant womennor their children were injected HBIG.
Of the 323 infants, 22 (6.81%) infants suffered from intrauterine infection, 10 of themchanged to HBsAg negative after the full vaccination. 15 had HBsAg-positive at 6 monthsold (6.05%), 10 of them had been intrauterine infection. 154 (47.68%) infants hadHBsAb-positive at 6 months old.
2. HBeAg and mother-to-child transmission of hepatitis B
63 cases (19.51%) of HBsAg-positive pregnant women had HBeAg positive. In thesingle-positive group (only HBsAg-positive), the rate of cesarean section was 77.31%,20.40% of which were for the purpose to prevent HBV infection. And the rate of artificialfeeding was 38.46%, 73.00% of which were for the purpose to prevent HBV infection. Theintrauterine infection rate of newborns was 25.40%. The chronic HBV rate of children was14.29%. Among the double-positive group (HBsAg-positive and HBeAg-positive), the rateof cesarean section was 90.48%, 63.16% of which were for the purpose to prevent HBV infection. And the rate of artificial feeding was 84.13%, 98. 11% of which were for thepurpose to prevent HBV infection. The intrauterine infection rate of newborns was 2.31%.The chronic HBV rate of children was 2.31%. Comparing with the single-positive group,the double-positive group have significantly higher rate not only the caesarean section andthe artificial feeding (χ~2=38.7788, P＜0.0001;χ~2=42.4181, P＜0.0001), but also theintrauterine infection and the chronic HBV infection of children (χ~2=42.5934, P＜0.0001;χ~2=16.4303, P＜0.001).
3. Factors of blocking measures and effect
Results of single factor analysis indicated that some factors correlated to the methodsand times of blocking measures, including maternal age, perinatal occupation, educationlevel, family per capita monthly income, occupation and education level of husband, theinitial time and place of prenatal care, delivery time and location. And the effect of blockingmeasures was correlated with HBV infection status of pregnant women, injected HBIGduring pregnancy or not, birth age, the initial time of prenatal care, infant HBIG injectionfrequency, times of breast-feeding and birth year.
After multi-factor analysis, we presumed that pregnancy HBIG injection was primarilyaffected by maternal age (OR=2.205), education level (OR=3.275), family per capitamonthly income (OR=1.693), birth year (OR=0.380), length of stay in hospital (OR=0.543)and husband occupation was staff occupational category (staff, business services staff,workers, migrant workers) (OR=2.205). If infants received more needles of HBIG injection(OR=3.873) and much longer breast-feeding (OR=9.815), they would be prone to haveHBsAb-positive at 6 months old.
5. Economic evaluation
The cost effectiveness ratio (CER) of mother-infant combine blocking to decrease theintrauterine infection was lower than only pregnancy blocking. Comparing with the onlyinfant blocking, the total CER of mother-infant combine blocking to decrease the chronicHBV infection of children was lower, and the direct CER was higher. The CER of mother-infant combine blocking to increase the antibody protection ratio surpassed the onlypregnancy blocking and only infant blocking. Mother-infant combine blocking wasoptimization among the three measures when being evaluated by cost-utility analysis,sensitivity analysis and incremental cost effectiveness analysis.
Conclusions
1. Pregnant women carrying rate of hepatitis B virus showed an upward trend overall,in Wuhan City in recent years.
2. Mother with HBeAg-positive is a high risk factor to the mother-to-childtransmission of HBV. However it was not given enough reconstruction by HBsAg-positivepregnant women.
3. HBsAg-positive pregnant women, in particular the mergers of HBeAg-positive, tendto choose cesarean section and artificial feeding. And in this study, the effect of cesareansection and artificial feeding on preventing mother-to-child transmission of hepatitis B hadno significantly difference. Cesarean section and artificial feeding are not the necessaryconditions to prevent mother-to-child transmission of hepatitis B.
4. The selection and effect of preventing mother-to-child transmission of hepatitis Bwill be affected not only by the individual, family factors, but also by the medicalenvironment.
5. Comparison from an economic point of view, the measure that mothers inject HBIGduring pregnancy and their children inject HBIG and hepatitis B vaccine after birth couldreduce major rate of intrauterine infection and chronic HBV infection of children, restoremore DALY, and could more effectively improve the rate of infants` antibody protection atthe same cost. Therefore, it is superior to other measures on preventing mother-to-childtransmission of hepatitis B in Wuhan City in recent years and should be recommended.
探讨影响乙肝母婴传播阻断干预措施选择的因素及主要干预措施的实质效果；对不同阻断措施的干预效果进行经济学评价，为选取最佳干预措施预防乙肝母婴传播提供科学依据。
研究方法
抽取武汉市2004年后住院分娩的、接受过系统产前检查的HBsAg阳性孕产妇及其婴儿进行回顾性现场调查研究和跟踪随访；调查方式为入户面对面问卷调查和一对一电话访谈。所有资料使用Spss10．0进行描述性分析、t检验、χ~2检验、非参数假设检验、单因素非条件logistic回归和多因素非条件logistic回归等统计学分析。
研究结果
1、阻断措施及效果：
本研究中孕产妇HBsAg阳性率为8．67％。323例调查对象中232人(71．83％)孕期注射了HBIG，其中90．00％以上首次注射HBIG时间在孕晚期，80．00％以上注射了3次；注射HBIG的婴儿有293人(90．71％)，其中276人(94．20％)注射1次。258人(79．88％)分娩方式为剖宫产，其中29．84％因乙肝因素剖宫产；153名(47．37％)婴儿人工喂养，其中81．70％因乙肝因素人工喂养。HBsAg阳性孕产妇胎膜早破的发生率、剖宫产率和人工喂养率均高于正常组孕产妇，差异有统计学意义(P＜0．05)。
323对调查的母子中，仅孕产妇在孕期注射过乙肝免疫球蛋白(HBIG)，23对(7．12％)；仅婴儿在出生后注射过HBIG(主被动免疫)，84对(26．00％)；孕产妇及其婴儿均注射过HBIG(母婴联合免疫)，209对(64．71％)；孕产妇及其婴儿均没有注射过HBIG，7对(2．17％)。
阻断后宫内感染22人(6．81％)，全程接种疫苗后，10人转阴，其中3人有抗体，7人全阴。婴儿慢性感染者15人(4．64％)，其中10人为宫内感染，3人后期感染。婴儿6个月后乙肝标志物检测，154人有抗体(47．68％)。
2、HBeAg与乙肝母婴传播：
HBsAg阳性合并乙肝e抗原(HBeAg)阳性孕产妇63人(19．51％)。双阳组剖宫产率(90．48％)高于单阳组(77．31％)，差异有统计学意义(χ~2=5．4709，P=0．00193)；因乙肝因素剖宫产的比例双阳组(63．16％)也明显高于单阳组(20．40％)，差异有统计学意义(χ~2=38．7788，P＜0．0001)。单阳组母乳喂养比例较高(61．54％)，双阳组则多为人工喂养(84．13％)，两组喂养方式差异有统计学意义(χ~2=42．4181，P＜0．0001)。人工喂养原因中因乙肝因素者，双阳组(98．11％)明显高于单阳组(73．00％)，差异有统计学意义(Fisher’Exact Test，P＜0．0001)。双阳组宫内感染率和慢性感染率为25．40％和14．29％，明显高于单阳组的2．31％，差异有统计学意义(χ~2=42．5934，16．4303，P＜0．001)。
3、影响阻断措施和效果的因素：
单因素分析中与阻断方式、次数等有关的因素有孕产妇年龄、围产期职业、文化程度、家庭人均月收入、丈夫职业和文化程度、初次产前检查时间和地点、分娩时间和地点等；与阻断效果有关的有孕产妇HBV感染状态、孕期是否注射HBIG、分娩年龄、初次产前检查时间、婴儿注射HBIG次数、母乳喂养时间和分娩年份。
多因素分析结果显示孕产妇分娩时年龄越大(OR=2．205)、孕产妇文化程度越高(OR=3．275)、家庭人均月收入越多(OR=1．693)、分娩时住院时间越短(OR=0．543)、分娩年份越早(OR=0．380)以及丈夫职业是员工类(公司职员／商业服务人员／工人／农民工)(OR=2．205)，孕产妇越趋向于选择孕期注射HBIG；婴儿注射HBIG次数越多(OR=3．873)、母乳喂养时间越长(OR=9．815)，婴儿6个月后越容易产生抗-HBs。
4、经济学分析：
减少宫内感染母婴联合阻断成本-效果比低于仅孕期阻断，减少婴儿慢性感染联合
阻断成本-效果比低于仅婴儿阻断，增加抗体保护率的成本效果联合阻断优于仅孕期阻断，更优于仅婴儿阻断。三种措施挽回的DALY及成本-效用比联合阻断措施最优，敏感性分析和增量成本-效果(效用)分析后结论未变。
研究结论
1、近年来武汉市孕产妇乙肝病毒携带率呈现整体上升趋势。
2、HBeAg阳性是影响乙肝母婴传播的重要因素，而孕产妇对其重视程度明显不足。
3、HBsAg阳性孕产妇，尤其是合并HBeAg阳性者，更趋向于剖宫产和人工喂养，而本研究中亦未见剖宫产和人工喂养与否对乙肝母婴传播阻断后效果的差异有统计学意义，认为剖宫产和人工喂养并非阻断乙肝母婴传播的必要条件。
4、乙肝母婴传播阻断措施的选择及效果不仅受个人、家庭因素影响，也与医疗环境息息相关。
5、从经济学角度综合比较，母亲孕期注射HBIG并婴儿出生后联合注射HBIG和乙肝疫苗的母婴联合阻断措施不仅在相同总成本下能够降低较多宫内感染率和婴儿慢性感染率，挽回较多DALY，还能更有效提高婴儿抗体保护率，优于其他措施，是武汉市近几年乙肝母婴传播阻断措施中最优措施，值得推荐。
Objectives
To explore the influential factors of choosing the blocking measures and the effects ofmain interventions. To evaluate the costs and effects of different blocking measures ofmother-to-child transmission of hepatitis B by the economic evaluation method, so as toselect the best intervention to prevent mother to child transmission of hepatitis B andprovide scientific evidence to the government and related departments to make reasonabledecisions.
Methods
The HBsAg-positive pregnant women and their children were taken out as studyobjects, who accepted prenatal care in district Maternal and Child Health Hospital ofWuhan City, from Jan 1st, 2004. Investigators who received strict training madeface-to-face or telephone interviews to these women with uniform questionnaires based ona voluntary and confidential principle. SPSS10.0 software was used to do data analysis,including descriptive analysis, t test. Chi-square test, nonparametric test, single factor andmulti-factor non-conditional logistic regression.
Results
1. Blocking measures and effect
The HBsAg positive rate among the pregnant women was 8.67%. 232 pregnant women (71.83%) were injected HBIG during pregnancy, and 90.00% of them began toinject in the third trimester of pregnancy. 90.00% of the pairs injected three needles. 293children were injected HBIG after birth, 94.20% of them accepted 1 needles. In the 323pregnant women, 258 (79.88%) had cesarean section, of which, 29.84% had cesareansection due to hepatitis B factors. 153 pregnant women (47.37%) developed artificialfeeding, 81.70% of which were owing to hepatitis B factors.
The incidence of premature rupture of membranes, cesarean section and artificialfeeding of HBsAg positive pregnant women were higher than those of normal pregnantwomen, with statistically significant difference (P＜0.05).
Among the 323 pairs of mothers and children, there were 23 pairs (7.12%) thatpregnant women without their children were injected HBIG during pregnancy. 84 pairs(26.00%) children alone were injected HBIG at birth and after birth (active and passiveimmunization). 209 pairs (64.71%) both pregnant women and their children were injectedHBIG (united maternal and child immunization). 7 pairs (2.17%) neither pregnant womennor their children were injected HBIG.
Of the 323 infants, 22 (6.81%) infants suffered from intrauterine infection, 10 of themchanged to HBsAg negative after the full vaccination. 15 had HBsAg-positive at 6 monthsold (6.05%), 10 of them had been intrauterine infection. 154 (47.68%) infants hadHBsAb-positive at 6 months old.
2. HBeAg and mother-to-child transmission of hepatitis B
63 cases (19.51%) of HBsAg-positive pregnant women had HBeAg positive. In thesingle-positive group (only HBsAg-positive), the rate of cesarean section was 77.31%,20.40% of which were for the purpose to prevent HBV infection. And the rate of artificialfeeding was 38.46%, 73.00% of which were for the purpose to prevent HBV infection. Theintrauterine infection rate of newborns was 25.40%. The chronic HBV rate of children was14.29%. Among the double-positive group (HBsAg-positive and HBeAg-positive), the rateof cesarean section was 90.48%, 63.16% of which were for the purpose to prevent HBV infection. And the rate of artificial feeding was 84.13%, 98. 11% of which were for thepurpose to prevent HBV infection. The intrauterine infection rate of newborns was 2.31%.The chronic HBV rate of children was 2.31%. Comparing with the single-positive group,the double-positive group have significantly higher rate not only the caesarean section andthe artificial feeding (χ~2=38.7788, P＜0.0001;χ~2=42.4181, P＜0.0001), but also theintrauterine infection and the chronic HBV infection of children (χ~2=42.5934, P＜0.0001;χ~2=16.4303, P＜0.001).
3. Factors of blocking measures and effect
Results of single factor analysis indicated that some factors correlated to the methodsand times of blocking measures, including maternal age, perinatal occupation, educationlevel, family per capita monthly income, occupation and education level of husband, theinitial time and place of prenatal care, delivery time and location. And the effect of blockingmeasures was correlated with HBV infection status of pregnant women, injected HBIGduring pregnancy or not, birth age, the initial time of prenatal care, infant HBIG injectionfrequency, times of breast-feeding and birth year.
After multi-factor analysis, we presumed that pregnancy HBIG injection was primarilyaffected by maternal age (OR=2.205), education level (OR=3.275), family per capitamonthly income (OR=1.693), birth year (OR=0.380), length of stay in hospital (OR=0.543)and husband occupation was staff occupational category (staff, business services staff,workers, migrant workers) (OR=2.205). If infants received more needles of HBIG injection(OR=3.873) and much longer breast-feeding (OR=9.815), they would be prone to haveHBsAb-positive at 6 months old.
5. Economic evaluation
The cost effectiveness ratio (CER) of mother-infant combine blocking to decrease theintrauterine infection was lower than only pregnancy blocking. Comparing with the onlyinfant blocking, the total CER of mother-infant combine blocking to decrease the chronicHBV infection of children was lower, and the direct CER was higher. The CER of mother-infant combine blocking to increase the antibody protection ratio surpassed the onlypregnancy blocking and only infant blocking. Mother-infant combine blocking wasoptimization among the three measures when being evaluated by cost-utility analysis,sensitivity analysis and incremental cost effectiveness analysis.
Conclusions
1. Pregnant women carrying rate of hepatitis B virus showed an upward trend overall,in Wuhan City in recent years.
2. Mother with HBeAg-positive is a high risk factor to the mother-to-childtransmission of HBV. However it was not given enough reconstruction by HBsAg-positivepregnant women.
3. HBsAg-positive pregnant women, in particular the mergers of HBeAg-positive, tendto choose cesarean section and artificial feeding. And in this study, the effect of cesareansection and artificial feeding on preventing mother-to-child transmission of hepatitis B hadno significantly difference. Cesarean section and artificial feeding are not the necessaryconditions to prevent mother-to-child transmission of hepatitis B.
4. The selection and effect of preventing mother-to-child transmission of hepatitis Bwill be affected not only by the individual, family factors, but also by the medicalenvironment.
5. Comparison from an economic point of view, the measure that mothers inject HBIGduring pregnancy and their children inject HBIG and hepatitis B vaccine after birth couldreduce major rate of intrauterine infection and chronic HBV infection of children, restoremore DALY, and could more effectively improve the rate of infants` antibody protection atthe same cost. Therefore, it is superior to other measures on preventing mother-to-childtransmission of hepatitis B in Wuhan City in recent years and should be recommended.
引文
1 World Health Organization.Hepatitis B Fact sheet,Revised August 2008.
2 Hou JL,Liu ZH,Gu F.Epidemiology and prevention of hepatitis B virus infection[J].Int J Med.Sci,2005,2(1):50-57.
3 梁晓峰，陈园生，王晓军等．中国3岁以上人群乙型肝炎血清流行病学研究[J]．中华流行病学杂志，2005,26(9)：655-658．
4 Kanwal F,Granlnek IM,Martin P,et al.Treatment alternatives for chronic hepatitis B virus infection: a cost-effectiveness analysis[J].Ann Intern Med,2005,142:821-831.
5 张玲霞．提高慢性乙型肝炎防治水平--解读《慢性乙型肝炎防治指南》[J]．解放军医学杂志，2006，31：377-378．
6 韩永战，陈仕珠．乙型肝炎病毒疫苗免疫接种策略及卫生经济学评价[J]．世界华人消化杂志，2006，14(27)：2722-2728．
7 Koedijk FD,op de Coul EL,Boot HJ,et al.[Hepatitis B surveillance in the Netherlands,2002-2005: acute infection is mainly via sexual contact while chronic infection is via vertical transmission through mothers from endemic regions] [J].Ned Tijdschr Geneeskd,2007,151(43):2389-2394.
8 Hsu EK,Murray KF.Hepatitis B and C in children[J].Nat Clin Pract Gastroenterol Hepatol,2008,5(6):311-320.
9 郑鹏远，唐芙爱，卢高峰等．慢乙肝母婴传播阻断和治疗策略的建议[J]．世界华人消化杂志，2007，15(1)：1-6．
10 朱启镕．重视与加强乙型肝炎病毒母婴传播的研究[J]．中华儿科杂志，2006，44(12)：883-885．
11 吴君．乙型肝炎病毒感染的综合性预防[J]．世界华人消化杂志，2006，14(12)：1135-1138．
12 陈天艳，刘敏，陈云茹等．HBV宫内传播的研究进展[J]．世界华人消化杂志， 2007,15(19): 2138-2143.
13 Muszlak M,Lartigau-Roussin C,Farthouat L,et al.Vaccination of children against hepatitis B in Mayotte,French Comoros Island[J].Arch Pediatr,2007,14(9):1132-1136.
14 刘艳庚，陈萱．乙肝孕妇应用乙肝免疫球蛋白(HBIG)阻断母婴传播的研究[J]．中国优生与遗传杂志，2005，13(9)：121-123．
15 袁荣，王晨虹，刘晓梅，等．HBV母婴传播致新生儿免疫失败的原因和机制[J]．第四军医大学学报，2005，26(7)：647-649．
16 刘崇柏，苏崇鳌．对乙型肝炎免疫球蛋白阻断母婴围产期传播的浅见[J]．中国计划免疫，2006，12(2)：148-150．
17 王素萍，徐德忠．乙型肝炎病毒宫内感染的研究现状及今后工作重点[J]．中华流行病学杂志，2005，26(4)：229-231．
18 范祎，肖小敏．产前应用乙型肝炎免疫球蛋白对于阻断乙肝母婴宫内传播作用的Meta分析[J]．中国优生与遗传杂志，2007，15(1)：62-64．
19 张丽娜，邹琦，张璐．产前和产后联合阻断HBsAg阳性孕妇母婴传播的研究[J]．中华现代儿科学杂志，2005，2(6)：484-485．
20 李银姬，岳亚飞，张树林．HBIG联合HBVac阻断HBV宫内感染的研究[J]．中国优生与遗传杂志，2005，13(6)：67-69．
21 Xiao XM,Li AZ,Chen X,et al.Prevention of vertical hepatitis B transmission by hepatitis B immunoglobulin in the third trimester of pregnancy[J].Int J Gynaecol Obstet,2007,96(3):167-170.
22 范祎，肖小敏．分娩方式对乙肝病毒母婴垂直传播影响的Meta分析[J]．中国妇幼保健，2007，22(27)：3787-3789．
23 钱燕华．分娩方式对乙型肝炎母婴传播阻断效果的影响[J]．职业与健康，2006，22(17)：1332-1334．
24 齐振勇，葛丽娟．乙肝产妇血清及乳汁中HBVDNA含量相关性研究[J]．中国现代医生，2008，46(24)：152-152。
25 夏志刚，赵素元．乳汁中检测HBV．DNA及其临床意义[J]．中国医学检验杂志，2007，8(5)：331-332．
26 曾定元，莫可良，贺红英等．联合免疫后乙肝病毒携带产妇母乳喂养安全性的探讨[J]．现代妇产科进展，2006，15(2)：125-127．
27 Takeda A,Jones J,Shepherd J,et al.A systematic review and economic evaluation of adefovir dipivoxil and pegylated interferon-alpha-2a for the treatment of chronic hepatitis B[J].J Viral Hepat,2007,14(2):75-88.
28 Fagnani F,Le Fur C,Durand I,et al.Economic evaluation of a combined DTPa,hepatitis B,polio,Hib vaccine.Potential impact of the introduction of Infanrix-Hexa in the French childhood immunisation schedule[J].Eur J Health Econ,2004,5(2): 143-149.
29 Tilson L,Thornton L,O'Flanagan D,et al.Cost effectiveness of hepatitis B vaccination strategies in Ireland: an economic evaluation[J].Eur J Public Health,2008,18(3):275-282.
30 Vimolket T,Poovomwan Y.An economic evaluation of universal infant vaccination strategies against hepatitis B in Thailand: an analytic decision approach to cost-effectiveness[J].Southeast Asian J Trop Med Public Health,2005,May 36(3):693-699.
31 Giraudon I,Forde J,Maguire H,et al.Antenatal screening and prevalence of infection: surveillance in London,2000-2007[J].Euro Surveill,2009,14(9):8-12.
32 Salleras L,Dominguez A,Bruguera M,et al.Seroepidemiology of hepatitis B virus infection in pregnant women in Catalonia (Spain)[J].J Clin Virol,2009,44(4):329-332.
33 Elefsiniotis IS,Glynou I,Zorou I,et al.Surveillance for hepatitis B virus infection in pregnant women in Greece shows high rates of chronic infection among immigrants and low vaccination-induced protection rates: preliminary results of a single center study[J].Euro Surveill,2009,14(9):5-7.
34 Resuli B,Prifti S,Kraja B,et al.Epidemiology of hepatitis B virus infection in Albania[J].World J Gastroenterol,2009,15(7):849-852.
35 Lin CC,Hsieh HS,Huang YJ,et al.Hepatitis B virus infection among pregnant women in Taiwan: comparison between women bom in Taiwan and other southeast countries[J].BMC Public Health,2008,8:49-55.
36 余滨，周敦金，夏俊南等．武汉市2003年新生儿乙肝疫苗接种率及产妇乙肝病毒携带率的调查分析[J]．2005，20(11)：576-578．
37 Benson J,Donohue W.Hepatitis in refugees who settle in Australia[J].Aust Fam Physician,2007,36(9):719-727.
38 Nguyen G,Garcia RT,Nguyen N,et al.Clinical course of hepatitis B virus infection during pregnancy[J].Aliment Pharmacol Ther,2009,29(7):755-764.
39 Onah HE,Obi SN,Agbata TA,et al.Pregnancy outcome in HIV-positive women in Enugu,Nigeria[J].J Obstet Gynaecol,2007,27(3):271-274.
40 Lao TT,Chan BC,Leung WC,et al.Maternal hepatitis B infection and gestational diabetes mellitus[J].J Hepatol,2007,47(1):46-50.
41 Rathi U,Bapat M,Rathi P,et al.Effect of liver disease on maternal and fetal outcome--a prospective study[J].Indian J Gastroenterol,2007,26(2):59-63.
42 Zhao EY,Chen SL,Sun L,et al.Influence of chronic HBV infection in the husband on the outcome of IVF-ET treatment[J].Nan Fang Yi Ke Da Xue Xue Bao,2007,27(12):1827-1829.
43 Bista BK,Rana A.Acute hepatitis E in pregnancy--study of 16 cases[J].JNMA J Nepal Med Assoc,2006,45(161):182-185.
44 Gambarin-Gelwan M.Hepatitis B in pregnancy[J].Clin Liver Dis,2007,11(4):945-963.
45 刘东洋，肖小敏，周娟，张永良．影响乙肝病毒母婴传播中新生儿乙肝表面抗原转阴的因素探讨[J]．中国妇幼保健，2008，23(9)：1220-1222。
46 Quddus A,Luby SP,Jamal Z,et al.Prevalence of hepatitis B among Afghan refugees living in Balochistan,Pakistan[J].Int J Infect Dis,2006,10(3):242-247.
47 郭彩娇，杨红玲，陈小娟．乙肝血清学标志物与其HBV-DNA含量的对比分析[J]．中国妇幼保健，2005，20(7)：853-854．
48 王元，何成章，黄文琴等．联合免疫后乙肝病毒母婴传播相关因素的临床研究[J]．中国妇幼保健，2005，20(13)：1655-1657．
49 金春子，李萍，朱童．不同乙肝血清学指标阳性孕妇血清中HBV-DNA定量检测结果分析[J]．中国优生与遗传杂志，2007，15(6)：62-62，116．
50 Chakravarti A,Rawat D,Jain M.A study on the perinatal transmission of the hepatitis B virus[J].Indian J Med Microbiol,2005,23(2):128-130.
51 Terrault NA,Jacobson IM.Treating chronic hepatitis B infection in patients who are pregnant or are undergoing immunosuppressive chemotherapy[J].Semin Liver Dis,2007,27 Suppl 1:18-24.
52 Bacq Y.Hepatitis B and pregnancy[J].Gastroenterol Clin Biol,2008,32(1 Pt 2):S12-19.
53 Xu Q,Xiao L,Lu XB,et al.A randomized controlled clinical trial: interruption of intrauterine transmission of hepatitis B virus infection with HBIG[J].World J Gastroenterol,2006,12(21):3434-3437.
54 Yuan J,Lin J,Xu A,et al.Antepartum immunoprophylaxis of three doses of hepatitis B immunoglobulin is not effective: a single-centre randomized study[J].J Viral Hepat,2006,13(9):597-604.
55 陈素清，朱启镕．医源性HBV变异[J]．国外医学流行病学传染病学分册，2005，32：156-158．
56 陈素清，朱启镕，王建设．乙型肝炎免疫球蛋白阻断乙肝病毒母婴传播过程中病毒S区基因变异的研究[J]．中华流行病学杂志，2006，27(6)：522-525．
57 Xu H,Peng M,Qing Y,et al.A Quasi species of the pre-S/S gene and mutations of enhancer Ⅱ/core promoter/pre-C in mothers and their children infected with hepatitis B virus via mother-to-infant transmission[J].J Infect Dis,2006,193(1):88-97.
58 SAMUEL D.Management of hepatitis B in liver transplantation patient[J].Semin Liver Dis,2004,24(Suppl):55-62.
59 Lok A S,McMahon B J.Chronic hepatitis[J].Hepatology,2007,45(2):507-538.
60 Yang J,Zeng XM,Men YL,et al.Elective caesarean section versus vaginal delivery for preventing mother to child transmission of hepatitis B virus--a systematic review[J].Virol J,2008,5:100.
61 Read JS,Cannon MJ,Stanberry LR,et al.Prevention of mother-to-child transmission of viral infections[J].Curr Probl Pediatr Adolesc Health Care,2008,38(9):274-297.
62 Giles ML,Garland SM,Grover SR,et al.Impact of an education campaign on management in pregnancy of women infected with a blood-borne virus[J].Med J Aust,2006,184(8):389-392.
63 Tremolada S,Delbue S,Ferrante P.Viral infections of the fetus and newborn infant[J].Pediatr Med Chir,2008,30(4):177-191.
64 沈菁，潘敏，杨丽娟等．乙肝血清学阳性产妇乳汁中乙肝病毒检测及母婴传播的研究[J]．广西医科大学学报，2005，22(1)：76-77．
65 Lu YP,Cao W,Hong M,et al.A study on the relationship between point mutation in pre-core region G1896A of hepatitis B virus and safety of breast feeding[J].Zhonghua Yu Fang Yi Xue Za Zhi,2008,42(10):739-741.
66 Sookoian S.Liver disease during pregnancy: acute viral hepatitis[J].Ann Hepatol,2006,5(3):231-236.
67 Lawrence RM,Lawrence RA.Breast milk and infection[J].Clin Perinatol,2004,31(3):501-528.
68 杜玉开，刘毅，方为民等．妇幼卫生管理学[M]．2006年2月第1版版：人民卫生出版社，2006．
69 Rhiner J,Pfister R,Nassehi Tschopp Y,et al.Selective immunisation strategy to protect newborns at risk for transmission of hepatitis B: retrospective audit of vaccine uptake[J].Swiss Med Wkly,2007,137(37-38):531-535.
70 王富珍，齐亚莉，龚晓红等．北京市乙型肝炎病毒感染相关疾病疾病个人负担研究[J]．疾病控制杂志，2004，8(5)：389-392．
71 石光，谢永富，刘秀颖等．乙型肝炎经济负担的测算[J]．中国初级卫生保健，2004，18(8)：18-19．
72 Lopez AD,Mathers CD,Ezzati M,et al.Global and regional burden of disease and risk factors,2001: systematic analysis of population health data[J].Lancet,2006,367(9524):1747-1757.
73 Kim SY,Salomon JA,Goldie SJ.Economic evaluation of hepatitis B vaccination in low-income countries: using cost-effectiveness affordability curves[J].Bull World Health Organ,2007,85(11):833-842.
74 Essock SM,Covell NH,Jackson CT.Antipsychotic drugs and schizophrenia[J].N Engl J Med,2006,354(3):298-300; author reply 298-300.
75 Fabrizi F,Messa P,Martin P.Hepatitis B virus infection and the dialysis patient[J].Semin Dial,2008,21(5):440-446. Alavian SM,Fallahian F,Lankarani KB.The changing epidemiology of viral hepatitis B in Iran[J].J Gastrointestin Liver Dis,2007,16(4):403-406.
2 Pol S.Epidemiology and natural history of hepatitis B[J].Rev Prat,2005,55(6):599-606.
3 Shepard CW,Finelli L,Fiore AE,et al.Epidemiology of hepatitis B and hepatitis B virus infection in United States children[J].Pediatr Infect Dis J,2005,24(9):755-760.
4 Liu CJ,Chen DS,Chen PJ.Epidemiology of HBV infection in Asian blood donors: emphasis on occult HBV infection and the role of NAT[J].J Clin Virol,2006,36 Suppl 1:S33-44.
5 Murhekar MV,Murhekar KM,Sehgal SC.Epidemiology of hepatitis B virus infection among the tribes of Andaman and Nicobar Islands,India[J].Trans R Soc Trop Med Hyg,2008,102(8):729-734.
6 Datta S.An overview of molecular epidemiology of hepatitis B virus (HBV) in India[J].Virol J,2008,5:156-168
7 Parana R,Almeida D.HBV epidemiology in Latin America[J].J Clin Virol,2005,34 Suppl 1:S130-133.
8 胡权，黄建国，雷延昌等．武汉地区儿童乙型肝炎患者病毒S基因“a”决定簇变异的研究[J]．中华肝脏病杂志，2005，13(8)：594-596．
9 Yang J,Zeng XM,Men YL,et al.Elective caesarean section versus vaginal delivery for preventing mother to child transmission of hepatitis B virus--a systematic review[J].Virol J,2008,5:100-110.
10 李光伟，王春香，刁琳琪等．河南省1997-2002年乙型肝炎的流行病学特征分析[J]。现代预防医学，2005，32(7)：759-760．
11 曹志威，李灵辉，方艳等．广东省1991-2002年乙型病毒性肝炎流行情况分析[J]． 广东医学，2004，25(9)：1089-1090．
12 张发香，吴江明，赵明江等．湖北省2001-2007年乙型肝炎疫情分析[J]．中国社会医学杂志，2008，25(4)：251-253．
13 Bacq Y.[Hepatitis B and pregnancy] [J].Gastroenterol Clin Biol,2008,32(1 Pt 2):S12-19.
14 吴潭梅，古国荣，何玉影等．母体血液和新生儿脐带血乙肝血清标志物检测分析[J]．中华现代儿科学杂志，2005，2(3)：263-264．
15 Koedijk FD,op de Coul EL,Boot HJ,et al.Hepatitis B surveillance in the Netherlands,2002-2005: acute infection is mainly via sexual contact while chronic infection is via vertical transmission through mothers from endemic regions[J].Ned Tijdschr Geneeskd,2007,151(43):2389-2394.
16 Liu CY,Chang NT,Chou P.Seroprevalence of HBV in immigrant pregnant women and coverage of HBIG vaccine for neonates born to chronically infected immigrant mothers in Hsin-Chu County,Taiwan[J].Vaccine,2007,25(44):7706-7710.
17 McGovern BH.The epidemiology,natural history and prevention of hepatitis B: implications of HIV coinfection[J].Antivir Ther,2007,12 Suppl 3:H3-13.
18 Ali SA,Donahue RM,Qureshi H,et al.Hepatitis B and hepatitis C in Pakistan: prevalence and risk factors[J].Int J Infect Dis,2009,13(1):9-19.
19 Xu DZ,Yan YP,Choi BC,et al.Risk factors and mechanism of transplacental transmission of hepatitis B virus: a case-control study[J].J Med Virol,2002,67(1):20-26.
20 朱冰，苏媾莉，仇瑞珍．广州地区小儿乙肝无症状携带者及其父母的HBV DNA基因型研究[J]．中国优生与遗传杂志，2005，13(3)：19-20。
21 罗祎，姚珍薇．乙型肝炎病毒垂直传播机制的研究进展[J]．中华肝脏病杂志，2006，14(8)：638-640．
22 张先艳，张小娟，薛艳霞．乙肝病毒母婴垂直传播的阻断措施[J]．延安大学学报：医学科学版，2005，3(2)：31-31．
23 夏志刚，赵素元．乳汁中检测HBV．DNA及其临床意义[J]．中国医学检验杂志，2007，8(5)：331-332．
24 王元，何成章，黄文琴等．联合免疫后乙肝病毒母婴传播相关因素的临床研究[J]．中国妇幼保健，2005，20(13)：1655-1657．
25 曾定元，莫可良，贺红英等．联合免疫后乙肝病毒携带产妇母乳喂养安全性的探讨[J]．现代妇产科进展，2006，15(2)：125-127．
26 Liu ZY,Li XY,Yan XM,et al.Nested case-control study on the influence factors of perinatal stage transmission of hepatitis B virus[J].Zhong Nan Da Xue Xue Bao Yi Xue Ban,2007,32(3):451-454.
27 Xiao XM,Li AZ,Chen X,et al.Prevention of vertical hepatitis B transmission by hepatitis B immunoglobulin in the third trimester of pregnancy[J].Int J Gynaecol Obstet,2007,96(3):167-170.
28 Xu Q,Xiao L,Lu XB,et al.A randomized controlled clinical trial: interruption of intrauterine transmission of hepatitis B virus infection with HBIG[J].World J Gastroenterol,2006,12(21):3434-3437.
29 Tang H,Da L,Mao Y,et al.Hepatitis B virus X protein sensitizes cells to starvation-induced autophagy via up-regulation of beclin 1 expression[J].Hepatology,2009,49(1):60-71.
30 Gutkowski K,Gutkowska D,Lepiech J.[Viral hepatitis during pregnancy] [J].Ginekol Pol,2006,77(10):804-810.
31 金春子，李萍，朱童．不同乙肝血清学指标阳性孕妇血清中HBV-DNA定量检测结果分析[J]．中国优生与遗传杂志，2007，15(6)：62-62．
32 刘芬，蒋佩茹．60例孕妇HBV血清标志物水平与母婴传播的关系分析[J]．传染病信息，2005，18(3)：129-130．
33 游泳，邢爱耘，谭曦．慢性乙肝病毒感染孕妇之新生儿乙肝主／被动联合免疫效果观察[J]．四川大学学报：医学版，2007，38(3)：554-555．
34 王清图，修霞，郭永等．阻断乙型肝炎病毒母婴宫内传播对血清病毒DNA和转录 体影响的研究[J]．中华现代临床医学杂志，2005，3(9)：769-776．
35 李银姬，岳亚飞，张树林．HBIG联合HBVac阻断HBV宫内感染的研究[J]．中国优生与遗传杂志，2005，13(6)：67-69．
36 Han XB,Yue YF,Bai GQ,et al.Clinical significance of detecting neonatal peripheral blood mononuclear cells infected by HBV[J].Zhonghua Er Ke Za Zhi,2005,43(6):434-437.
37 Wang SP,Li TG,Wei JN,et al.Study on hepatitis B virus intrauterine infection state and its correlation factors[J].Zhonghua Fu Chan Ke Za Zhi,2005,40(10):670-672.
38 de Man RA,van der Eijck A,Veldhuijzen I.New aspects on diagnosis and transmission of hepatitis B in pediatric patients and pregnant women[J].Adv Exp Med Biol,2008,609:64-71.
39 Shepard CW,Simard EP,Finelli L,et al.Hepatitis B virus infection: epidemiology and vaccination[J].Epidemiol Rev,2006,28:112-25.
40 Wang FY,Lin P,Zhang HZ.[A randomized controlled trial on effect of hepatitis B immune globulin in preventing hepatitis B virus transmission from mothers to infants] [J].Zhonghua Er Ke Za Zhi,2008,46(1):61-63.
41 Inaba N,Oshima K,Nishikawa M,et al.Improved methods for prevention of mother-to-child transmission of hepatitis B virus[J].Nippon Rinsho,2007,65 Suppl 3:513-517.
42 Gomber S,Sharma R,Ramachandran VG.Immunogenicity of low dose intradermal hepatitis B vaccine and its comparison with standard dose intramuscular vaccination[J].Indian Pediatr,2004,41(9):922-926.
43 张新华，曾丽浓，叶梅芳等．不同剂量国产重组酵母乙肝疫苗单用或联合乙肝免疫球蛋白对母婴传播阻断效果的研究比较[J]．临床和实验医学杂志，2008，7(4)：93-94．
44 杨翠丽，王斯，马文阁等．不同剂量乙肝疫苗联合乙肝免疫球蛋白阻断乙肝母婴传播探讨[J]．河北医药，2008，30(10)：1493-1494．
45 Zuckerman JN.Review: hepatitis B immune globulin for prevention of hepatitis B infection[J].J Med Virol,2007,79(7):919-921.
46 彭忠田，谭德明，黄顺玲等．HBIG抑制HBsAg、HBV DNA分泌的体外实验研究[J]．中国感染控制杂志，2008，7(4)：237-241．
47 郭秀文，于立君．HBIG与乙肝疫苗联合应用对阻断HBV母婴传播的效果分析[J]．中华临床医学研究杂志，2007，13(8)：1102-1103．
48 范祎，肖小敏．产前应用乙型肝炎免疫球蛋白对于阻断乙肝母婴宫内传播作用的Meta分析[J]．中国优生与遗传杂志，2007，15(1)：62-64．
49 林平，王福彦，边保华等．不同方法注射乙肝免疫球蛋白阻断HBsAg、HBeAg双阳性孕妇母婴传播的研究[J]．中国优生与遗传杂志，2007，15(9)：62-63．
50 赵越，纪桂芳，闫树新等．经乙型肝炎母婴阻断出生之婴幼儿核心抗体消失时限观察[J]．传染病信息，2005，18(2)：88-88．
51 朱萍，曾蔚越．孕期不同阶段应用HBIG阻断乙肝母婴传播效果初探[J]．中国优生与遗传杂志，2007，15(9)：58-61．
52 马文英．早孕期使用HBIG阻断HBV宫内传播的临床研究[J]．中国药业，2008，17(21)：60-61．
53 Han ZH,Zhong LH,Wang J,et al.The impact of antepartum injection of hepatitis B immunoglobulin on maternal serum HBV DNA and anti-HBs in the newborns[J].Zhonghua Nei Ke Za Zhi,2007,46(5):376-378.
54 Yuan J,Lin J,Xu A,et al.Antepartum immunoprophylaxis of three doses of hepatitis B immunoglobulin is not effective: a single-centre randomized study[J].J Viral Hepat,2006,13(9):597-604.
55 刘权，周湛，陈宏丽等．HBIG4+3法阻断乙型肝炎母婴传播的效果观察[J]．中国卫生工程学，2005，4(6)：363-364．
56 吴雪清．联合免疫有效降低乙肝病毒宫内传播的临床研究[J]．临床医学，2005，25(6)：20-21．
57 李艮亮，张霞，王馥美．联合免疫阻断乙肝病毒母婴垂直传播的临床观察[J]．中 国现代医药杂志，2007，9(7)：105-106．
58 郑九生，张红玲，夏丽琴，等．产前注射HBIG及新生儿HBIG联合乙肝疫苗预防乙肝病毒母婴传播[J]．实用临床医学(江西)，2006，7(6)：21-23．
59 张丽娜，邹琦，张璐．产前和产后联合阻断HBsAg阳性孕妇母婴传播的研究[J]．中华现代儿科学杂志，2005，2(6)：484-485．
60 王赞，杨淑云．不同方法阻断乙肝母婴垂直传播两年后的效果观察[J]．中外健康文摘·医药卫生版，2007，4(7)：114-114．
61 范祎，肖小敏，郦爱贞，等．分娩方式对乙肝病毒母婴垂直传播的影响[J]．广东医学，2007，28(2)：252-253．
62 范祎，肖小敏．分娩方式对乙肝病毒母婴垂直传播影响的Meta分析[J]．中国妇幼保健，2007，22(27)：3787-3789．
63 Wang J,Zhu Q,Zhang x.Effect of delivery mode on matemal-infant transmission of hepatitis B vires by immunoprophylaxis[J].Chin Med J(Engl),2002,115:1510-1512.
64 钱燕华．分娩方式对乙型肝炎母婴传播阻断效果的影响[J]．职业与健康， 2006，22(17)：1332-1334．
2 Hou JL,Liu ZH,Gu F.Epidemiology and prevention of hepatitis B virus infection[J].Int J Med.Sci,2005,2(1):50-57.
3 梁晓峰，陈园生，王晓军等．中国3岁以上人群乙型肝炎血清流行病学研究[J]．中华流行病学杂志，2005,26(9)：655-658．
4 Kanwal F,Granlnek IM,Martin P,et al.Treatment alternatives for chronic hepatitis B virus infection: a cost-effectiveness analysis[J].Ann Intern Med,2005,142:821-831.
5 张玲霞．提高慢性乙型肝炎防治水平--解读《慢性乙型肝炎防治指南》[J]．解放军医学杂志，2006，31：377-378．
6 韩永战，陈仕珠．乙型肝炎病毒疫苗免疫接种策略及卫生经济学评价[J]．世界华人消化杂志，2006，14(27)：2722-2728．
7 Koedijk FD,op de Coul EL,Boot HJ,et al.[Hepatitis B surveillance in the Netherlands,2002-2005: acute infection is mainly via sexual contact while chronic infection is via vertical transmission through mothers from endemic regions] [J].Ned Tijdschr Geneeskd,2007,151(43):2389-2394.
8 Hsu EK,Murray KF.Hepatitis B and C in children[J].Nat Clin Pract Gastroenterol Hepatol,2008,5(6):311-320.
9 郑鹏远，唐芙爱，卢高峰等．慢乙肝母婴传播阻断和治疗策略的建议[J]．世界华人消化杂志，2007，15(1)：1-6．
10 朱启镕．重视与加强乙型肝炎病毒母婴传播的研究[J]．中华儿科杂志，2006，44(12)：883-885．
11 吴君．乙型肝炎病毒感染的综合性预防[J]．世界华人消化杂志，2006，14(12)：1135-1138．
12 陈天艳，刘敏，陈云茹等．HBV宫内传播的研究进展[J]．世界华人消化杂志， 2007,15(19): 2138-2143.
13 Muszlak M,Lartigau-Roussin C,Farthouat L,et al.Vaccination of children against hepatitis B in Mayotte,French Comoros Island[J].Arch Pediatr,2007,14(9):1132-1136.
14 刘艳庚，陈萱．乙肝孕妇应用乙肝免疫球蛋白(HBIG)阻断母婴传播的研究[J]．中国优生与遗传杂志，2005，13(9)：121-123．
15 袁荣，王晨虹，刘晓梅，等．HBV母婴传播致新生儿免疫失败的原因和机制[J]．第四军医大学学报，2005，26(7)：647-649．
16 刘崇柏，苏崇鳌．对乙型肝炎免疫球蛋白阻断母婴围产期传播的浅见[J]．中国计划免疫，2006，12(2)：148-150．
17 王素萍，徐德忠．乙型肝炎病毒宫内感染的研究现状及今后工作重点[J]．中华流行病学杂志，2005，26(4)：229-231．
18 范祎，肖小敏．产前应用乙型肝炎免疫球蛋白对于阻断乙肝母婴宫内传播作用的Meta分析[J]．中国优生与遗传杂志，2007，15(1)：62-64．
19 张丽娜，邹琦，张璐．产前和产后联合阻断HBsAg阳性孕妇母婴传播的研究[J]．中华现代儿科学杂志，2005，2(6)：484-485．
20 李银姬，岳亚飞，张树林．HBIG联合HBVac阻断HBV宫内感染的研究[J]．中国优生与遗传杂志，2005，13(6)：67-69．
21 Xiao XM,Li AZ,Chen X,et al.Prevention of vertical hepatitis B transmission by hepatitis B immunoglobulin in the third trimester of pregnancy[J].Int J Gynaecol Obstet,2007,96(3):167-170.
22 范祎，肖小敏．分娩方式对乙肝病毒母婴垂直传播影响的Meta分析[J]．中国妇幼保健，2007，22(27)：3787-3789．
23 钱燕华．分娩方式对乙型肝炎母婴传播阻断效果的影响[J]．职业与健康，2006，22(17)：1332-1334．
24 齐振勇，葛丽娟．乙肝产妇血清及乳汁中HBVDNA含量相关性研究[J]．中国现代医生，2008，46(24)：152-152。
25 夏志刚，赵素元．乳汁中检测HBV．DNA及其临床意义[J]．中国医学检验杂志，2007，8(5)：331-332．
26 曾定元，莫可良，贺红英等．联合免疫后乙肝病毒携带产妇母乳喂养安全性的探讨[J]．现代妇产科进展，2006，15(2)：125-127．
27 Takeda A,Jones J,Shepherd J,et al.A systematic review and economic evaluation of adefovir dipivoxil and pegylated interferon-alpha-2a for the treatment of chronic hepatitis B[J].J Viral Hepat,2007,14(2):75-88.
28 Fagnani F,Le Fur C,Durand I,et al.Economic evaluation of a combined DTPa,hepatitis B,polio,Hib vaccine.Potential impact of the introduction of Infanrix-Hexa in the French childhood immunisation schedule[J].Eur J Health Econ,2004,5(2): 143-149.
29 Tilson L,Thornton L,O'Flanagan D,et al.Cost effectiveness of hepatitis B vaccination strategies in Ireland: an economic evaluation[J].Eur J Public Health,2008,18(3):275-282.
30 Vimolket T,Poovomwan Y.An economic evaluation of universal infant vaccination strategies against hepatitis B in Thailand: an analytic decision approach to cost-effectiveness[J].Southeast Asian J Trop Med Public Health,2005,May 36(3):693-699.
31 Giraudon I,Forde J,Maguire H,et al.Antenatal screening and prevalence of infection: surveillance in London,2000-2007[J].Euro Surveill,2009,14(9):8-12.
32 Salleras L,Dominguez A,Bruguera M,et al.Seroepidemiology of hepatitis B virus infection in pregnant women in Catalonia (Spain)[J].J Clin Virol,2009,44(4):329-332.
33 Elefsiniotis IS,Glynou I,Zorou I,et al.Surveillance for hepatitis B virus infection in pregnant women in Greece shows high rates of chronic infection among immigrants and low vaccination-induced protection rates: preliminary results of a single center study[J].Euro Surveill,2009,14(9):5-7.
34 Resuli B,Prifti S,Kraja B,et al.Epidemiology of hepatitis B virus infection in Albania[J].World J Gastroenterol,2009,15(7):849-852.
35 Lin CC,Hsieh HS,Huang YJ,et al.Hepatitis B virus infection among pregnant women in Taiwan: comparison between women bom in Taiwan and other southeast countries[J].BMC Public Health,2008,8:49-55.
36 余滨，周敦金，夏俊南等．武汉市2003年新生儿乙肝疫苗接种率及产妇乙肝病毒携带率的调查分析[J]．2005，20(11)：576-578．
37 Benson J,Donohue W.Hepatitis in refugees who settle in Australia[J].Aust Fam Physician,2007,36(9):719-727.
38 Nguyen G,Garcia RT,Nguyen N,et al.Clinical course of hepatitis B virus infection during pregnancy[J].Aliment Pharmacol Ther,2009,29(7):755-764.
39 Onah HE,Obi SN,Agbata TA,et al.Pregnancy outcome in HIV-positive women in Enugu,Nigeria[J].J Obstet Gynaecol,2007,27(3):271-274.
40 Lao TT,Chan BC,Leung WC,et al.Maternal hepatitis B infection and gestational diabetes mellitus[J].J Hepatol,2007,47(1):46-50.
41 Rathi U,Bapat M,Rathi P,et al.Effect of liver disease on maternal and fetal outcome--a prospective study[J].Indian J Gastroenterol,2007,26(2):59-63.
42 Zhao EY,Chen SL,Sun L,et al.Influence of chronic HBV infection in the husband on the outcome of IVF-ET treatment[J].Nan Fang Yi Ke Da Xue Xue Bao,2007,27(12):1827-1829.
43 Bista BK,Rana A.Acute hepatitis E in pregnancy--study of 16 cases[J].JNMA J Nepal Med Assoc,2006,45(161):182-185.
44 Gambarin-Gelwan M.Hepatitis B in pregnancy[J].Clin Liver Dis,2007,11(4):945-963.
45 刘东洋，肖小敏，周娟，张永良．影响乙肝病毒母婴传播中新生儿乙肝表面抗原转阴的因素探讨[J]．中国妇幼保健，2008，23(9)：1220-1222。
46 Quddus A,Luby SP,Jamal Z,et al.Prevalence of hepatitis B among Afghan refugees living in Balochistan,Pakistan[J].Int J Infect Dis,2006,10(3):242-247.
47 郭彩娇，杨红玲，陈小娟．乙肝血清学标志物与其HBV-DNA含量的对比分析[J]．中国妇幼保健，2005，20(7)：853-854．
48 王元，何成章，黄文琴等．联合免疫后乙肝病毒母婴传播相关因素的临床研究[J]．中国妇幼保健，2005，20(13)：1655-1657．
49 金春子，李萍，朱童．不同乙肝血清学指标阳性孕妇血清中HBV-DNA定量检测结果分析[J]．中国优生与遗传杂志，2007，15(6)：62-62，116．
50 Chakravarti A,Rawat D,Jain M.A study on the perinatal transmission of the hepatitis B virus[J].Indian J Med Microbiol,2005,23(2):128-130.
51 Terrault NA,Jacobson IM.Treating chronic hepatitis B infection in patients who are pregnant or are undergoing immunosuppressive chemotherapy[J].Semin Liver Dis,2007,27 Suppl 1:18-24.
52 Bacq Y.Hepatitis B and pregnancy[J].Gastroenterol Clin Biol,2008,32(1 Pt 2):S12-19.
53 Xu Q,Xiao L,Lu XB,et al.A randomized controlled clinical trial: interruption of intrauterine transmission of hepatitis B virus infection with HBIG[J].World J Gastroenterol,2006,12(21):3434-3437.
54 Yuan J,Lin J,Xu A,et al.Antepartum immunoprophylaxis of three doses of hepatitis B immunoglobulin is not effective: a single-centre randomized study[J].J Viral Hepat,2006,13(9):597-604.
55 陈素清，朱启镕．医源性HBV变异[J]．国外医学流行病学传染病学分册，2005，32：156-158．
56 陈素清，朱启镕，王建设．乙型肝炎免疫球蛋白阻断乙肝病毒母婴传播过程中病毒S区基因变异的研究[J]．中华流行病学杂志，2006，27(6)：522-525．
57 Xu H,Peng M,Qing Y,et al.A Quasi species of the pre-S/S gene and mutations of enhancer Ⅱ/core promoter/pre-C in mothers and their children infected with hepatitis B virus via mother-to-infant transmission[J].J Infect Dis,2006,193(1):88-97.
58 SAMUEL D.Management of hepatitis B in liver transplantation patient[J].Semin Liver Dis,2004,24(Suppl):55-62.
59 Lok A S,McMahon B J.Chronic hepatitis[J].Hepatology,2007,45(2):507-538.
60 Yang J,Zeng XM,Men YL,et al.Elective caesarean section versus vaginal delivery for preventing mother to child transmission of hepatitis B virus--a systematic review[J].Virol J,2008,5:100.
61 Read JS,Cannon MJ,Stanberry LR,et al.Prevention of mother-to-child transmission of viral infections[J].Curr Probl Pediatr Adolesc Health Care,2008,38(9):274-297.
62 Giles ML,Garland SM,Grover SR,et al.Impact of an education campaign on management in pregnancy of women infected with a blood-borne virus[J].Med J Aust,2006,184(8):389-392.
63 Tremolada S,Delbue S,Ferrante P.Viral infections of the fetus and newborn infant[J].Pediatr Med Chir,2008,30(4):177-191.
64 沈菁，潘敏，杨丽娟等．乙肝血清学阳性产妇乳汁中乙肝病毒检测及母婴传播的研究[J]．广西医科大学学报，2005，22(1)：76-77．
65 Lu YP,Cao W,Hong M,et al.A study on the relationship between point mutation in pre-core region G1896A of hepatitis B virus and safety of breast feeding[J].Zhonghua Yu Fang Yi Xue Za Zhi,2008,42(10):739-741.
66 Sookoian S.Liver disease during pregnancy: acute viral hepatitis[J].Ann Hepatol,2006,5(3):231-236.
67 Lawrence RM,Lawrence RA.Breast milk and infection[J].Clin Perinatol,2004,31(3):501-528.
68 杜玉开，刘毅，方为民等．妇幼卫生管理学[M]．2006年2月第1版版：人民卫生出版社，2006．
69 Rhiner J,Pfister R,Nassehi Tschopp Y,et al.Selective immunisation strategy to protect newborns at risk for transmission of hepatitis B: retrospective audit of vaccine uptake[J].Swiss Med Wkly,2007,137(37-38):531-535.
70 王富珍，齐亚莉，龚晓红等．北京市乙型肝炎病毒感染相关疾病疾病个人负担研究[J]．疾病控制杂志，2004，8(5)：389-392．
71 石光，谢永富，刘秀颖等．乙型肝炎经济负担的测算[J]．中国初级卫生保健，2004，18(8)：18-19．
72 Lopez AD,Mathers CD,Ezzati M,et al.Global and regional burden of disease and risk factors,2001: systematic analysis of population health data[J].Lancet,2006,367(9524):1747-1757.
73 Kim SY,Salomon JA,Goldie SJ.Economic evaluation of hepatitis B vaccination in low-income countries: using cost-effectiveness affordability curves[J].Bull World Health Organ,2007,85(11):833-842.
74 Essock SM,Covell NH,Jackson CT.Antipsychotic drugs and schizophrenia[J].N Engl J Med,2006,354(3):298-300; author reply 298-300.
75 Fabrizi F,Messa P,Martin P.Hepatitis B virus infection and the dialysis patient[J].Semin Dial,2008,21(5):440-446. Alavian SM,Fallahian F,Lankarani KB.The changing epidemiology of viral hepatitis B in Iran[J].J Gastrointestin Liver Dis,2007,16(4):403-406.
2 Pol S.Epidemiology and natural history of hepatitis B[J].Rev Prat,2005,55(6):599-606.
3 Shepard CW,Finelli L,Fiore AE,et al.Epidemiology of hepatitis B and hepatitis B virus infection in United States children[J].Pediatr Infect Dis J,2005,24(9):755-760.
4 Liu CJ,Chen DS,Chen PJ.Epidemiology of HBV infection in Asian blood donors: emphasis on occult HBV infection and the role of NAT[J].J Clin Virol,2006,36 Suppl 1:S33-44.
5 Murhekar MV,Murhekar KM,Sehgal SC.Epidemiology of hepatitis B virus infection among the tribes of Andaman and Nicobar Islands,India[J].Trans R Soc Trop Med Hyg,2008,102(8):729-734.
6 Datta S.An overview of molecular epidemiology of hepatitis B virus (HBV) in India[J].Virol J,2008,5:156-168
7 Parana R,Almeida D.HBV epidemiology in Latin America[J].J Clin Virol,2005,34 Suppl 1:S130-133.
8 胡权，黄建国，雷延昌等．武汉地区儿童乙型肝炎患者病毒S基因“a”决定簇变异的研究[J]．中华肝脏病杂志，2005，13(8)：594-596．
9 Yang J,Zeng XM,Men YL,et al.Elective caesarean section versus vaginal delivery for preventing mother to child transmission of hepatitis B virus--a systematic review[J].Virol J,2008,5:100-110.
10 李光伟，王春香，刁琳琪等．河南省1997-2002年乙型肝炎的流行病学特征分析[J]。现代预防医学，2005，32(7)：759-760．
11 曹志威，李灵辉，方艳等．广东省1991-2002年乙型病毒性肝炎流行情况分析[J]． 广东医学，2004，25(9)：1089-1090．
12 张发香，吴江明，赵明江等．湖北省2001-2007年乙型肝炎疫情分析[J]．中国社会医学杂志，2008，25(4)：251-253．
13 Bacq Y.[Hepatitis B and pregnancy] [J].Gastroenterol Clin Biol,2008,32(1 Pt 2):S12-19.
14 吴潭梅，古国荣，何玉影等．母体血液和新生儿脐带血乙肝血清标志物检测分析[J]．中华现代儿科学杂志，2005，2(3)：263-264．
15 Koedijk FD,op de Coul EL,Boot HJ,et al.Hepatitis B surveillance in the Netherlands,2002-2005: acute infection is mainly via sexual contact while chronic infection is via vertical transmission through mothers from endemic regions[J].Ned Tijdschr Geneeskd,2007,151(43):2389-2394.
16 Liu CY,Chang NT,Chou P.Seroprevalence of HBV in immigrant pregnant women and coverage of HBIG vaccine for neonates born to chronically infected immigrant mothers in Hsin-Chu County,Taiwan[J].Vaccine,2007,25(44):7706-7710.
17 McGovern BH.The epidemiology,natural history and prevention of hepatitis B: implications of HIV coinfection[J].Antivir Ther,2007,12 Suppl 3:H3-13.
18 Ali SA,Donahue RM,Qureshi H,et al.Hepatitis B and hepatitis C in Pakistan: prevalence and risk factors[J].Int J Infect Dis,2009,13(1):9-19.
19 Xu DZ,Yan YP,Choi BC,et al.Risk factors and mechanism of transplacental transmission of hepatitis B virus: a case-control study[J].J Med Virol,2002,67(1):20-26.
20 朱冰，苏媾莉，仇瑞珍．广州地区小儿乙肝无症状携带者及其父母的HBV DNA基因型研究[J]．中国优生与遗传杂志，2005，13(3)：19-20。
21 罗祎，姚珍薇．乙型肝炎病毒垂直传播机制的研究进展[J]．中华肝脏病杂志，2006，14(8)：638-640．
22 张先艳，张小娟，薛艳霞．乙肝病毒母婴垂直传播的阻断措施[J]．延安大学学报：医学科学版，2005，3(2)：31-31．
23 夏志刚，赵素元．乳汁中检测HBV．DNA及其临床意义[J]．中国医学检验杂志，2007，8(5)：331-332．
24 王元，何成章，黄文琴等．联合免疫后乙肝病毒母婴传播相关因素的临床研究[J]．中国妇幼保健，2005，20(13)：1655-1657．
25 曾定元，莫可良，贺红英等．联合免疫后乙肝病毒携带产妇母乳喂养安全性的探讨[J]．现代妇产科进展，2006，15(2)：125-127．
26 Liu ZY,Li XY,Yan XM,et al.Nested case-control study on the influence factors of perinatal stage transmission of hepatitis B virus[J].Zhong Nan Da Xue Xue Bao Yi Xue Ban,2007,32(3):451-454.
27 Xiao XM,Li AZ,Chen X,et al.Prevention of vertical hepatitis B transmission by hepatitis B immunoglobulin in the third trimester of pregnancy[J].Int J Gynaecol Obstet,2007,96(3):167-170.
28 Xu Q,Xiao L,Lu XB,et al.A randomized controlled clinical trial: interruption of intrauterine transmission of hepatitis B virus infection with HBIG[J].World J Gastroenterol,2006,12(21):3434-3437.
29 Tang H,Da L,Mao Y,et al.Hepatitis B virus X protein sensitizes cells to starvation-induced autophagy via up-regulation of beclin 1 expression[J].Hepatology,2009,49(1):60-71.
30 Gutkowski K,Gutkowska D,Lepiech J.[Viral hepatitis during pregnancy] [J].Ginekol Pol,2006,77(10):804-810.
31 金春子，李萍，朱童．不同乙肝血清学指标阳性孕妇血清中HBV-DNA定量检测结果分析[J]．中国优生与遗传杂志，2007，15(6)：62-62．
32 刘芬，蒋佩茹．60例孕妇HBV血清标志物水平与母婴传播的关系分析[J]．传染病信息，2005，18(3)：129-130．
33 游泳，邢爱耘，谭曦．慢性乙肝病毒感染孕妇之新生儿乙肝主／被动联合免疫效果观察[J]．四川大学学报：医学版，2007，38(3)：554-555．
34 王清图，修霞，郭永等．阻断乙型肝炎病毒母婴宫内传播对血清病毒DNA和转录 体影响的研究[J]．中华现代临床医学杂志，2005，3(9)：769-776．
35 李银姬，岳亚飞，张树林．HBIG联合HBVac阻断HBV宫内感染的研究[J]．中国优生与遗传杂志，2005，13(6)：67-69．
36 Han XB,Yue YF,Bai GQ,et al.Clinical significance of detecting neonatal peripheral blood mononuclear cells infected by HBV[J].Zhonghua Er Ke Za Zhi,2005,43(6):434-437.
37 Wang SP,Li TG,Wei JN,et al.Study on hepatitis B virus intrauterine infection state and its correlation factors[J].Zhonghua Fu Chan Ke Za Zhi,2005,40(10):670-672.
38 de Man RA,van der Eijck A,Veldhuijzen I.New aspects on diagnosis and transmission of hepatitis B in pediatric patients and pregnant women[J].Adv Exp Med Biol,2008,609:64-71.
39 Shepard CW,Simard EP,Finelli L,et al.Hepatitis B virus infection: epidemiology and vaccination[J].Epidemiol Rev,2006,28:112-25.
40 Wang FY,Lin P,Zhang HZ.[A randomized controlled trial on effect of hepatitis B immune globulin in preventing hepatitis B virus transmission from mothers to infants] [J].Zhonghua Er Ke Za Zhi,2008,46(1):61-63.
41 Inaba N,Oshima K,Nishikawa M,et al.Improved methods for prevention of mother-to-child transmission of hepatitis B virus[J].Nippon Rinsho,2007,65 Suppl 3:513-517.
42 Gomber S,Sharma R,Ramachandran VG.Immunogenicity of low dose intradermal hepatitis B vaccine and its comparison with standard dose intramuscular vaccination[J].Indian Pediatr,2004,41(9):922-926.
43 张新华，曾丽浓，叶梅芳等．不同剂量国产重组酵母乙肝疫苗单用或联合乙肝免疫球蛋白对母婴传播阻断效果的研究比较[J]．临床和实验医学杂志，2008，7(4)：93-94．
44 杨翠丽，王斯，马文阁等．不同剂量乙肝疫苗联合乙肝免疫球蛋白阻断乙肝母婴传播探讨[J]．河北医药，2008，30(10)：1493-1494．
45 Zuckerman JN.Review: hepatitis B immune globulin for prevention of hepatitis B infection[J].J Med Virol,2007,79(7):919-921.
46 彭忠田，谭德明，黄顺玲等．HBIG抑制HBsAg、HBV DNA分泌的体外实验研究[J]．中国感染控制杂志，2008，7(4)：237-241．
47 郭秀文，于立君．HBIG与乙肝疫苗联合应用对阻断HBV母婴传播的效果分析[J]．中华临床医学研究杂志，2007，13(8)：1102-1103．
48 范祎，肖小敏．产前应用乙型肝炎免疫球蛋白对于阻断乙肝母婴宫内传播作用的Meta分析[J]．中国优生与遗传杂志，2007，15(1)：62-64．
49 林平，王福彦，边保华等．不同方法注射乙肝免疫球蛋白阻断HBsAg、HBeAg双阳性孕妇母婴传播的研究[J]．中国优生与遗传杂志，2007，15(9)：62-63．
50 赵越，纪桂芳，闫树新等．经乙型肝炎母婴阻断出生之婴幼儿核心抗体消失时限观察[J]．传染病信息，2005，18(2)：88-88．
51 朱萍，曾蔚越．孕期不同阶段应用HBIG阻断乙肝母婴传播效果初探[J]．中国优生与遗传杂志，2007，15(9)：58-61．
52 马文英．早孕期使用HBIG阻断HBV宫内传播的临床研究[J]．中国药业，2008，17(21)：60-61．
53 Han ZH,Zhong LH,Wang J,et al.The impact of antepartum injection of hepatitis B immunoglobulin on maternal serum HBV DNA and anti-HBs in the newborns[J].Zhonghua Nei Ke Za Zhi,2007,46(5):376-378.
54 Yuan J,Lin J,Xu A,et al.Antepartum immunoprophylaxis of three doses of hepatitis B immunoglobulin is not effective: a single-centre randomized study[J].J Viral Hepat,2006,13(9):597-604.
55 刘权，周湛，陈宏丽等．HBIG4+3法阻断乙型肝炎母婴传播的效果观察[J]．中国卫生工程学，2005，4(6)：363-364．
56 吴雪清．联合免疫有效降低乙肝病毒宫内传播的临床研究[J]．临床医学，2005，25(6)：20-21．
57 李艮亮，张霞，王馥美．联合免疫阻断乙肝病毒母婴垂直传播的临床观察[J]．中 国现代医药杂志，2007，9(7)：105-106．
58 郑九生，张红玲，夏丽琴，等．产前注射HBIG及新生儿HBIG联合乙肝疫苗预防乙肝病毒母婴传播[J]．实用临床医学(江西)，2006，7(6)：21-23．
59 张丽娜，邹琦，张璐．产前和产后联合阻断HBsAg阳性孕妇母婴传播的研究[J]．中华现代儿科学杂志，2005，2(6)：484-485．
60 王赞，杨淑云．不同方法阻断乙肝母婴垂直传播两年后的效果观察[J]．中外健康文摘·医药卫生版，2007，4(7)：114-114．
61 范祎，肖小敏，郦爱贞，等．分娩方式对乙肝病毒母婴垂直传播的影响[J]．广东医学，2007，28(2)：252-253．
62 范祎，肖小敏．分娩方式对乙肝病毒母婴垂直传播影响的Meta分析[J]．中国妇幼保健，2007，22(27)：3787-3789．
63 Wang J,Zhu Q,Zhang x.Effect of delivery mode on matemal-infant transmission of hepatitis B vires by immunoprophylaxis[J].Chin Med J(Engl),2002,115:1510-1512.
64 钱燕华．分娩方式对乙型肝炎母婴传播阻断效果的影响[J]．职业与健康， 2006，22(17)：1332-1334．