CAJ | 학술논문

目的了解我国妇女孕前或孕期感染人类免疫缺陷病毒( human immunodeficiency virus,HIV)所致的母婴传播情况及其影响因素. 方法选取2000年1月至2009年12月我国中部地区部分县市及新疆伊宁市277例孕前或孕期感染HIV的女性及其分娩的322例子代为研究对象,分析HIV亚型及母婴传播率.采用x2检验及Logistic回归分析探讨相关影响因素.结果 277例孕前或孕期感染HIV的女性中,199例为血液途径感染,其中174例HIV亚型检测成功,均为B'亚型,而通过性传播途径感染的78例女性中,58例HIV亚型检测成功,以重组型CRF01-BC和CRF-AE为主,分别为35例(60.3％)和20例(34.5％),仅3例(5.2％)为B’型.322例子代中接受HIV检测前死亡12例,余310例接受HIV检测的子代中108例为阳性,HIV母婴传播率为34.8％ (95％ CI:29.5％～40.1％)；单因素分析显示,人工喂养者的子代HIV阳性率低于母乳喂养者[12.5％(6/48)与38.9％(102/262),x2=12.484,P=0.000];母亲感染HIV的年限＜7年者的母婴传播率低于感染年限≥7年者[28.8％(46/160)与54.2％(32/59),x2=12.211,P=0.000].多因素Logistic回归分析提示女性感染HIV年限(OR=1.342,95％CI:1.189～1.515,P=0.000)和母乳喂养持续时间(OR=1.137,95％CI:1.053～1.227,P=0.001)是HIV母婴传播的危险因素.结论女性HIV感染后HIV亚型与其传播途径有关.人工喂养可以降低HIV母婴传播率,女性HIV感染年限长、母乳喂养持续时间久可增加HIV母婴传播率.
목적 료해아국부녀잉전혹잉기감염인류면역결함병독( human immunodeficiency virus,HIV)소치적모영전파정황급기영향인소. 방법 선취2000년1월지2009년12월아국중부지구부분현시급신강이저시277례잉전혹잉기감염HIV적녀성급기분면적322례자대위연구대상,분석HIV아형급모영전파솔.채용x2검험급Logistic회귀분석탐토상관영향인소.결과 277례잉전혹잉기감염HIV적녀성중,199례위혈액도경감염,기중174례HIV아형검측성공,균위B'아형,이통과성전파도경감염적78례녀성중,58례HIV아형검측성공,이중조형CRF01-BC화CRF-AE위주,분별위35례(60.3％)화20례(34.5％),부3례(5.2％)위B’형.322례자대중접수HIV검측전사망12례,여310례접수HIV검측적자대중108례위양성,HIV모영전파솔위34.8％ (95％ CI:29.5％～40.1％)；단인소분석현시,인공위양자적자대HIV양성솔저우모유위양자[12.5％(6/48)여38.9％(102/262),x2=12.484,P=0.000];모친감염HIV적년한＜7년자적모영전파솔저우감염년한≥7년자[28.8％(46/160)여54.2％(32/59),x2=12.211,P=0.000].다인소Logistic회귀분석제시녀성감염HIV년한(OR=1.342,95％CI:1.189～1.515,P=0.000)화모유위양지속시간(OR=1.137,95％CI:1.053～1.227,P=0.001)시HIV모영전파적위험인소.결론 녀성HIV감염후HIV아형여기전파도경유관.인공위양가이강저HIV모영전파솔,녀성HIV감염년한장、모유위양지속시간구가증가HIV모영전파솔.
Objective To investigate the situation of mother to child transmission of HIV after mothers acquired HIV prenatally or before pregnancy and the related factors. Methods Two hundred and seventy-seven mothers who acquired HIV prenatally or before pregnancy and their 322children from Yi-ning city of Xinjiang Uygur autonomous region and some counties of central China were enrolled in this study from January 2000 to December 2009.Subtypes of HIV were determined by detection of Gag sequence,the rate of HIV transmission from mother to child was calculated and its related factors were analyzed by Chi-square test and Logistic regression analysis. Results The HIV subtype of all mothers who were infected through blood (n=174) was B'.The major subtype of mothers who were infected via sexuality (n =58) was recombined subtype CRF01-BC (n=35) and CRF-AE (n=20),accounting for 60.3％ and 34.5％,respectively,and only 3 mothers with B'subtype (5.2％).Twelve infants died before HIV detection,and 108 infants out of the rest 310infants were found to be HIV positive, giving the HIV mother-to-child transmission rate of 34.8％ (95％ CI:29.5％-40.1％).The infection rate of bottle feeding infants was lower than that of breastfeeding infants [12.5％ (6/48) vs 38.9％ (102/262),x2 =12.484,P=0.000].The infection rate of the infants whose mothers' HIV infection ＜7 years was lower than that of the infants whose mothers' HIV infection ≥7 years [28.8％ (46/160) vs 54.2％ (32/59),x2 =12.211,P=0.000].Multi-factor Logistic analysis showed that the duration of maternal HIV infection (OR =1.342,95％ CI:1.189-1.515,P=0.000) and duration of breastfeeding (OR =1.137,95％ CI:1.053-1.227,P=0.001) were risk factors of HIV vertical transmission. Conclusions The HIV subtypes might be associated with transmission route.Formula feeding could decrease the vertical transmission rate of HIV,while long duration of maternal HIV infection and breastfeeding might increase the vertical transmission rate of HIV.