中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2009年
11期
805-808
,共4页
张荣莲%陈起燕%谢婧娴%罗颖%成玲%郭胜斌%黄欣欣
張榮蓮%陳起燕%謝婧嫻%囉穎%成玲%郭勝斌%黃訢訢
장영련%진기연%사청한%라영%성령%곽성빈%황흔흔
肝炎%乙型%肝炎病毒%乙型%DNA%病毒%疾病传播%垂直%危险因素
肝炎%乙型%肝炎病毒%乙型%DNA%病毒%疾病傳播%垂直%危險因素
간염%을형%간염병독%을형%DNA%병독%질병전파%수직%위험인소
Hepatitis B%Hepatitis B virus%DNA%viral%Disease transmission%vertical%Risk factors
目的 探讨乙型肝炎病毒(HBV)父婴垂直传播的危险因素及HBV DNA载量对HBV父婴垂直传播的影响.方法 选择2007年9月-2008年12月在福建省妇幼保健院行产前初诊检查的161例HBsAg阴性而丈夫HBsAg阳性的孕妇,以HBsAg阳性丈夫及其新生儿作为研究对象.观察指标包括一般情况、HBV携带时间、父亲乙型肝炎一级家族史、HBV标志物、HBV DNA载量、孕妇HBsAb状态、新生儿临床结局.分娩时收集新生儿脐带血进行HBV DNA定量检测,以脐带血HBVDNA载量≥1.0×103 copy/ml为病例组,脐带血HBV DNA＜1.0×103 copy/ml为对照组.结果 (1)HBV父婴垂直传播率:161例父亲HBsAg阳性的新生儿中,有36例脐带血HBV DNA检测呈阳性,即HBV父婴垂直传播率为22.4%(36/161),其中父亲乙型肝炎e抗原(HBeAg)阳性的传播率为32.0%(23/72),父亲HBeAg阴性的传播率为14.6%(13/89).(2)单因素分析结果:父亲HBeAg阳性、父亲HBV DNA阳性、父亲有乙型肝炎一级家族史及父亲HBV携带时间为父婴垂直传播的危险因素,X2值及OR值分别为6.892及2.7、29.916及5.2、29.499及8.3、23.821及1.4,差异均有统计学意义(P＜0.01).(3)多因素分析结果:父亲血清HBV DNA阳性及父亲有乙型肝炎一级家族史是HBV父婴垂直传播的危险因素,OR值及95%Cl值分别为11.1及4.6～27.1、17.1及3.5～82.6.(4)父亲血清HBV DNA载量与HBV父婴垂直传播的关系:随着父亲血清HBV DNA载量的升高,新生儿脐带血HBV DNA阳性率也逐渐升高,父亲血清HBV DNA载量＜1.0×104 copy/ml时,新生儿脐带血HBVDNA阳性率为0;载量≥1.0×108 copy/ml时,新生儿阳性率为100%.两者呈剂量反应关系.(5)新生儿临床结局:两组新生儿平均出生体重均为(3.3±0.4)kg.两组新生儿分娩方式、分娩孕周、身长、1分钟Apgar评分、新生儿病理性黄疽及合并其他内外科疾病情况进行比较,差异均无统计学意义(P＞0.05),HBV父婴垂直传播与新生儿临床结局无相关性(P＞0.05).结论 父亲血清HBV DNA载量及乙型肝炎一级家族史是HBV父婴垂直传播的危险因素;当父亲HBV DNA载量≥1.0×107 copy/ml时,HBV父婴垂直传播率增加.
目的 探討乙型肝炎病毒(HBV)父嬰垂直傳播的危險因素及HBV DNA載量對HBV父嬰垂直傳播的影響.方法 選擇2007年9月-2008年12月在福建省婦幼保健院行產前初診檢查的161例HBsAg陰性而丈伕HBsAg暘性的孕婦,以HBsAg暘性丈伕及其新生兒作為研究對象.觀察指標包括一般情況、HBV攜帶時間、父親乙型肝炎一級傢族史、HBV標誌物、HBV DNA載量、孕婦HBsAb狀態、新生兒臨床結跼.分娩時收集新生兒臍帶血進行HBV DNA定量檢測,以臍帶血HBVDNA載量≥1.0×103 copy/ml為病例組,臍帶血HBV DNA＜1.0×103 copy/ml為對照組.結果 (1)HBV父嬰垂直傳播率:161例父親HBsAg暘性的新生兒中,有36例臍帶血HBV DNA檢測呈暘性,即HBV父嬰垂直傳播率為22.4%(36/161),其中父親乙型肝炎e抗原(HBeAg)暘性的傳播率為32.0%(23/72),父親HBeAg陰性的傳播率為14.6%(13/89).(2)單因素分析結果:父親HBeAg暘性、父親HBV DNA暘性、父親有乙型肝炎一級傢族史及父親HBV攜帶時間為父嬰垂直傳播的危險因素,X2值及OR值分彆為6.892及2.7、29.916及5.2、29.499及8.3、23.821及1.4,差異均有統計學意義(P＜0.01).(3)多因素分析結果:父親血清HBV DNA暘性及父親有乙型肝炎一級傢族史是HBV父嬰垂直傳播的危險因素,OR值及95%Cl值分彆為11.1及4.6～27.1、17.1及3.5～82.6.(4)父親血清HBV DNA載量與HBV父嬰垂直傳播的關繫:隨著父親血清HBV DNA載量的升高,新生兒臍帶血HBV DNA暘性率也逐漸升高,父親血清HBV DNA載量＜1.0×104 copy/ml時,新生兒臍帶血HBVDNA暘性率為0;載量≥1.0×108 copy/ml時,新生兒暘性率為100%.兩者呈劑量反應關繫.(5)新生兒臨床結跼:兩組新生兒平均齣生體重均為(3.3±0.4)kg.兩組新生兒分娩方式、分娩孕週、身長、1分鐘Apgar評分、新生兒病理性黃疽及閤併其他內外科疾病情況進行比較,差異均無統計學意義(P＞0.05),HBV父嬰垂直傳播與新生兒臨床結跼無相關性(P＞0.05).結論 父親血清HBV DNA載量及乙型肝炎一級傢族史是HBV父嬰垂直傳播的危險因素;噹父親HBV DNA載量≥1.0×107 copy/ml時,HBV父嬰垂直傳播率增加.
목적 탐토을형간염병독(HBV)부영수직전파적위험인소급HBV DNA재량대HBV부영수직전파적영향.방법 선택2007년9월-2008년12월재복건성부유보건원행산전초진검사적161례HBsAg음성이장부HBsAg양성적잉부,이HBsAg양성장부급기신생인작위연구대상.관찰지표포괄일반정황、HBV휴대시간、부친을형간염일급가족사、HBV표지물、HBV DNA재량、잉부HBsAb상태、신생인림상결국.분면시수집신생인제대혈진행HBV DNA정량검측,이제대혈HBVDNA재량≥1.0×103 copy/ml위병례조,제대혈HBV DNA＜1.0×103 copy/ml위대조조.결과 (1)HBV부영수직전파솔:161례부친HBsAg양성적신생인중,유36례제대혈HBV DNA검측정양성,즉HBV부영수직전파솔위22.4%(36/161),기중부친을형간염e항원(HBeAg)양성적전파솔위32.0%(23/72),부친HBeAg음성적전파솔위14.6%(13/89).(2)단인소분석결과:부친HBeAg양성、부친HBV DNA양성、부친유을형간염일급가족사급부친HBV휴대시간위부영수직전파적위험인소,X2치급OR치분별위6.892급2.7、29.916급5.2、29.499급8.3、23.821급1.4,차이균유통계학의의(P＜0.01).(3)다인소분석결과:부친혈청HBV DNA양성급부친유을형간염일급가족사시HBV부영수직전파적위험인소,OR치급95%Cl치분별위11.1급4.6～27.1、17.1급3.5～82.6.(4)부친혈청HBV DNA재량여HBV부영수직전파적관계:수착부친혈청HBV DNA재량적승고,신생인제대혈HBV DNA양성솔야축점승고,부친혈청HBV DNA재량＜1.0×104 copy/ml시,신생인제대혈HBVDNA양성솔위0;재량≥1.0×108 copy/ml시,신생인양성솔위100%.량자정제량반응관계.(5)신생인림상결국:량조신생인평균출생체중균위(3.3±0.4)kg.량조신생인분면방식、분면잉주、신장、1분종Apgar평분、신생인병이성황저급합병기타내외과질병정황진행비교,차이균무통계학의의(P＞0.05),HBV부영수직전파여신생인림상결국무상관성(P＞0.05).결론 부친혈청HBV DNA재량급을형간염일급가족사시HBV부영수직전파적위험인소;당부친HBV DNA재량≥1.0×107 copy/ml시,HBV부영수직전파솔증가.
Objective To explore the risk factors of and the influence of different hepatitis B virus (HBV) DNA load on paternal vertical transmission of HBV.Methods Totally,161 HBsAg negative women,whose husband was HBsAg positive,attended the antenatal clinics of the Provincial Maternity and Child Health Hospital of Fujian from September 2007 to December 2008 and their newborns were selected,and the epidemiologic information,the duration of being a HBV carrier,the first class HBV family history of the fathers,HBV markers,HBV DNA load,HBsAb of the gravidas,the outcomes of the newborns were all collected.Cord blood was sampled after delivery for HBV DNA quantification and those with HBV DNA load ≥1.0×103 copy/ml were chosen as the case group and those ＜ 1.0×103 copy/ml as control.Results (1) Among the 161 newborns,36 HBV DNA positive cord blood samples were detected,giving a rate of 22.4% (36/161) for paternal vertical transmission of HBV.The HBV DNA positive rate in cord blood was 32.0% (23/72) in HBeAg-positive fathers and 14.6% (13/89) in HBeAg-negative fathers.(2) Univariate analysis showed that HBeAg-positive,HBV DNA positive,first class family history of HBV and the duration of being a HBV carrier of the fathers were risk factors of paternal HBV vertical transmission[X2= 6.892,29.916,29.499 and 23.821,OR = 2.7,5.2,8.3 and 1.4 (P＜0.01)].(3) Multivariate analysis found that paternal serum HBV DNA positive and the first class family history of HBV of the father side were risk factors of paternal vertical transmission of HBV (OR = 11.1,95% CI;4.6-27.1;OR = 17.1,95% CI:3.5-82.6).(4) According to the different serum HBV DNA load of the HBsAg-positive father,7 groups were divided.A dose dependent effect was found that the HBV DNA positive rate of the cord blood increased with the rising of HBV DNA load.No HBV DNA positive cord blood was detected when paternal HBV DNA load was＜1.0×104 copy/ml,while 100% of the cord blood were positive when paternal HBV DNA load≥1.0×108 copy/ml.(5) The average birth weight of the newborns in the two groups was the same (3.3±0.4) kg.And the delivery mode,gestational age at delivery,height and Apgar score of the newborns at 1 minute,neonatal pathological jaundice and other complications had no significant difference between the two groups (P ＞ 0.05).No relationship was found between the neonatal outcomes and the paternal HBV vertical transmission (P＞0.05).Conclusions HBV DNA load in the serum of HBsAg-positive father,and the paternal first class family history of HBV are risk factors of paternal HBV vertical transmission.When the serum HBV DNA load in HBsAg-positive father is≥1.0×107 copy/ml,the possibility of paternal vertical transmission of HBV would increase.
