中华流行病学杂志
中華流行病學雜誌
중화류행병학잡지
CHINESE JOURNAL OF EPIDEMIOLOGY
2012年
12期
1283-1287
,共5页
张荣莲%王梅颖%陈起燕%修晓燕%任坤海%邱丽茵%黄欣欣
張榮蓮%王梅穎%陳起燕%脩曉燕%任坤海%邱麗茵%黃訢訢
장영련%왕매영%진기연%수효연%임곤해%구려인%황흔흔
乙型肝炎病毒%垂直传播%危险因素
乙型肝炎病毒%垂直傳播%危險因素
을형간염병독%수직전파%위험인소
Hepatitis B virus%Vertical transmission%Risk factors
目的 探讨父母双方均为乙型肝炎病毒(HBV)感染者其垂直传播的危险因素及感染率.方法 选择2010年8月至2011年11月在福建省妇幼保健院行产前检查夫妻双方均为HBsAg阳性的46个孕妇家庭及其新生儿为研究对象.分娩时收集新生儿脐带血,进行血清HBV标志物(HBVM)、HBV-DNA检测,以脐带血HBV-DNA载量≥5×102 copies/ml为病例组,此值以下为对照组.结果 新生儿脐带血HBV-DNA阳性率为45.7％(21/46),HBsAg阳性率为34.8％(16/46),HBeAg阳性率为23.9％(11/46)；母亲血清HBV-DNA阳性率为52.2％(24/46),HBeAg阳性率为39.1％(18/46)；父亲血清HBV-DNA阳性率为69.6％ (32/46),HBeAg阳性率为32.6％(15/46).单因素分析表明,孕妇血清HBsAg阳性HBVM不同模式、HBeAg阳性、HBV-DNA阳性和HBV-DNA载量及其配偶血清HBsAg阳性HBVM不同模式、HBeAg阳性、HBV-DNA阳性和HBV-DNA载量为HBV垂直传播的危险因素,x2值分别为8.731、8.414、8.932、9.663、10.823、3.962、13.638、36.501,差异均有统计学意义(P＜0.05).多因素分析表明,孕妇血清HBV-DNA阳性及其配偶血清HBV-DNA载量是夫妻双方HBV感染垂直传播的危险因素,OR值及其95％CI分别为17.6(1.3 ～238.4)和3.5(1.6～7.6)；夫妻双方血清HBV-DNA载量均与脐带血HBV-DNA载量呈正相关,其血清HBV-DNA载量均＞脐带血HBV-DNA载量.随着父母双方血清HBV-DNA载量的升高,新生儿脐带血HBV-DNA载量也逐渐升高,两者存在剂量反应关系；ROC曲线分析表明,孕妇血清HBV-DNA载量为103 copies/ml、其配偶血清HBV-DAN载量在104 copies/ml时预测的敏感性与特异性较高,为预测HBV垂直传播发生的分界点,病例组和对照组新生儿结局差异均无统计学意义(P＞0.05)；对脐带血HBV-DNA阳性新生儿随访至第7个月时,阴转率为15.0％(3/20).结论 母亲血清HBV-DNA阳性、父亲血清HBV-DNA载量是其亲子HBV垂直传播的危险因素；母亲血清HBV-DNA载量＞103 copies/ml、父亲血清HBV-DAN载量＞104 copies/ml时,HBV亲子垂直传播的阳性率增加.
目的 探討父母雙方均為乙型肝炎病毒(HBV)感染者其垂直傳播的危險因素及感染率.方法 選擇2010年8月至2011年11月在福建省婦幼保健院行產前檢查伕妻雙方均為HBsAg暘性的46箇孕婦傢庭及其新生兒為研究對象.分娩時收集新生兒臍帶血,進行血清HBV標誌物(HBVM)、HBV-DNA檢測,以臍帶血HBV-DNA載量≥5×102 copies/ml為病例組,此值以下為對照組.結果 新生兒臍帶血HBV-DNA暘性率為45.7％(21/46),HBsAg暘性率為34.8％(16/46),HBeAg暘性率為23.9％(11/46)；母親血清HBV-DNA暘性率為52.2％(24/46),HBeAg暘性率為39.1％(18/46)；父親血清HBV-DNA暘性率為69.6％ (32/46),HBeAg暘性率為32.6％(15/46).單因素分析錶明,孕婦血清HBsAg暘性HBVM不同模式、HBeAg暘性、HBV-DNA暘性和HBV-DNA載量及其配偶血清HBsAg暘性HBVM不同模式、HBeAg暘性、HBV-DNA暘性和HBV-DNA載量為HBV垂直傳播的危險因素,x2值分彆為8.731、8.414、8.932、9.663、10.823、3.962、13.638、36.501,差異均有統計學意義(P＜0.05).多因素分析錶明,孕婦血清HBV-DNA暘性及其配偶血清HBV-DNA載量是伕妻雙方HBV感染垂直傳播的危險因素,OR值及其95％CI分彆為17.6(1.3 ～238.4)和3.5(1.6～7.6)；伕妻雙方血清HBV-DNA載量均與臍帶血HBV-DNA載量呈正相關,其血清HBV-DNA載量均＞臍帶血HBV-DNA載量.隨著父母雙方血清HBV-DNA載量的升高,新生兒臍帶血HBV-DNA載量也逐漸升高,兩者存在劑量反應關繫；ROC麯線分析錶明,孕婦血清HBV-DNA載量為103 copies/ml、其配偶血清HBV-DAN載量在104 copies/ml時預測的敏感性與特異性較高,為預測HBV垂直傳播髮生的分界點,病例組和對照組新生兒結跼差異均無統計學意義(P＞0.05)；對臍帶血HBV-DNA暘性新生兒隨訪至第7箇月時,陰轉率為15.0％(3/20).結論 母親血清HBV-DNA暘性、父親血清HBV-DNA載量是其親子HBV垂直傳播的危險因素；母親血清HBV-DNA載量＞103 copies/ml、父親血清HBV-DAN載量＞104 copies/ml時,HBV親子垂直傳播的暘性率增加.
목적 탐토부모쌍방균위을형간염병독(HBV)감염자기수직전파적위험인소급감염솔.방법 선택2010년8월지2011년11월재복건성부유보건원행산전검사부처쌍방균위HBsAg양성적46개잉부가정급기신생인위연구대상.분면시수집신생인제대혈,진행혈청HBV표지물(HBVM)、HBV-DNA검측,이제대혈HBV-DNA재량≥5×102 copies/ml위병례조,차치이하위대조조.결과 신생인제대혈HBV-DNA양성솔위45.7％(21/46),HBsAg양성솔위34.8％(16/46),HBeAg양성솔위23.9％(11/46)；모친혈청HBV-DNA양성솔위52.2％(24/46),HBeAg양성솔위39.1％(18/46)；부친혈청HBV-DNA양성솔위69.6％ (32/46),HBeAg양성솔위32.6％(15/46).단인소분석표명,잉부혈청HBsAg양성HBVM불동모식、HBeAg양성、HBV-DNA양성화HBV-DNA재량급기배우혈청HBsAg양성HBVM불동모식、HBeAg양성、HBV-DNA양성화HBV-DNA재량위HBV수직전파적위험인소,x2치분별위8.731、8.414、8.932、9.663、10.823、3.962、13.638、36.501,차이균유통계학의의(P＜0.05).다인소분석표명,잉부혈청HBV-DNA양성급기배우혈청HBV-DNA재량시부처쌍방HBV감염수직전파적위험인소,OR치급기95％CI분별위17.6(1.3 ～238.4)화3.5(1.6～7.6)；부처쌍방혈청HBV-DNA재량균여제대혈HBV-DNA재량정정상관,기혈청HBV-DNA재량균＞제대혈HBV-DNA재량.수착부모쌍방혈청HBV-DNA재량적승고,신생인제대혈HBV-DNA재량야축점승고,량자존재제량반응관계；ROC곡선분석표명,잉부혈청HBV-DNA재량위103 copies/ml、기배우혈청HBV-DAN재량재104 copies/ml시예측적민감성여특이성교고,위예측HBV수직전파발생적분계점,병례조화대조조신생인결국차이균무통계학의의(P＞0.05)；대제대혈HBV-DNA양성신생인수방지제7개월시,음전솔위15.0％(3/20).결론 모친혈청HBV-DNA양성、부친혈청HBV-DNA재량시기친자HBV수직전파적위험인소；모친혈청HBV-DNA재량＞103 copies/ml、부친혈청HBV-DAN재량＞104 copies/ml시,HBV친자수직전파적양성솔증가.
Objective To explore the risk factors and the rate of HBV vertical transmission from HBsAg-positive couple to their infant.Methods 46 families who had antenatal examination at Fujian Provincial Maternal and Child Health Hospital during August 2010 and November 2011 were chosen as research object.Cord blood was sampled after delivery for HBVM and HBV-DNA quantification.Those with HBV-DNA load ≥5 × 102 copies/ml were involved in the case group while those having ＜5 × 102 copies/ml were chosen as controls.Results The average positive rate of neonatal cord blood HBV-DNA was 45.7％ (21/46),while the positive rates of cord blood HBsAg and HBeAg were 34.8％(16/46) and 23.9％ (11/46) respectively.The positive rates of maternal serum HBV-DNA and paternal serum HBV-DNA were 52.2％ (24/46) and 69.6％ (32/46) respectively,with the positive rate of couple serum HBeAg as 39.1％ (18/46) and 32.6％(15/46) respectively.Results from univariate analysis showed that hepatitis B surface markers,serum HBeAg-positive,serum HBV-DNA positive,and serum HBV-DNA load of the couples were risk factors to the HBV vertical transmission(x2＝8.731,8.414,8.932,9.663,10.823,3.962,13.638,36.501 ;P＜0.05).Data from the multivariate analysis showed that maternal serum HBV-DNA positive and paternal serum HBV-DNA load were risk factors to the HBV vertical transmission [OR＝ 17.6 (1.3-238.4) ;OR ＝ 3.5 (1.6-7.6)].Serum HBV-DNA loads of the couples were positively correlated with the cord blood HBV-DNA load,while the load levels of the couple' s serum HBV-DNA were higher than cord blood HBV-DNA.There appeared dose-response relationship between couple' s serum HBV-DNA load level and the cord blood HBV-DNA load level.Results from the analysis of ROC curve showed that both maternal serum HBV-DNA load level (103 copies/ml) and paternal serum HBV-DNA load level (104 copies/ml) were demarcation points to better forecast the occurrence of vertical transmission of HBV,because there showed higher sensitivity and specificity for the forecasting process.Neonatal outcomes showed no significant difference between the case group and the control group.The negative conversion rate became 15.0％ (3/20) when the HBV-DNA positive infants were followed up for 7 months.Conclusion Both maternal serum HBV-DNA positive and paternal serum HBV-DNA load were risk factors of HBV vertical transmission.When the maternal serum HBV-DNA load appeared ＞103 copies/ml and paternal serum HBV-DNA load ＞ 104 copies/ml,the rate of HBV vertical transmission would increase.
