CAJ | 학술논문

目的：探讨妊娠合并HIV感染孕妇的母婴阻断效果及阻断时机。方法将2010年1月至2013年6月本院收治的126例妊娠合并HIV感染孕妇，按照开始抗反转录病毒治疗的时间，分为孕期治疗组、产前治疗组及未治疗组。并将孕期治疗组分为早中孕治疗组和晚孕治疗组。所有患者均给予三联高效抗反转录病毒药物治疗（HAART），同时采取安全分娩及人工喂养等综合干预措施。观察各组的不良妊娠结局、新生儿不良结局及母婴阻断效果。结果孕期治疗组的不良妊娠结局发生率（3.95%，3/74）显著低于产前治疗组（20.00%，8/45）及未治疗组（42.86%，3/7），差异均具有统计学意义（χ2=14.448，P ＜0.05）。孕期治疗组的新生儿不良结局发生率（9.46%，7/74）显著低于产前治疗组（22.22%，10/45）及未治疗组（50%，3/6），差异具有统计学意义（χ2=8.742， P ＜0.05）。对82例存活婴儿完成随访，孕期治疗组无1例婴儿感染HIV，产前治疗组的婴儿HIV感染率（9.68%，3/31）显著低于未治疗组（33.33%，1/3），差异具有统计学意义（χ2=9.235，P ＜0.05）。早中孕治疗组的不良妊娠结局发生率、新生儿不良结局发生率及婴儿感染HIV率与晚孕治疗组相比，差异均无统计学意义（P＞0.05）。结论妊娠合并HIV感染的患者，其妊娠结局及新生儿预后与患者开始HAART的时间密切相关，孕期采用HAART治疗者显著优于产前治疗者和未治疗者，且HAART对胎儿的生长发育未见明显不良影响。
목적：탐토임신합병HIV감염잉부적모영조단효과급조단시궤。방법장2010년1월지2013년6월본원수치적126례임신합병HIV감염잉부，안조개시항반전록병독치료적시간，분위잉기치료조、산전치료조급미치료조。병장잉기치료조분위조중잉치료조화만잉치료조。소유환자균급여삼련고효항반전록병독약물치료（HAART），동시채취안전분면급인공위양등종합간예조시。관찰각조적불량임신결국、신생인불량결국급모영조단효과。결과잉기치료조적불량임신결국발생솔（3.95%，3/74）현저저우산전치료조（20.00%，8/45）급미치료조（42.86%，3/7），차이균구유통계학의의（χ2=14.448，P ＜0.05）。잉기치료조적신생인불량결국발생솔（9.46%，7/74）현저저우산전치료조（22.22%，10/45）급미치료조（50%，3/6），차이구유통계학의의（χ2=8.742， P ＜0.05）。대82례존활영인완성수방，잉기치료조무1례영인감염HIV，산전치료조적영인HIV감염솔（9.68%，3/31）현저저우미치료조（33.33%，1/3），차이구유통계학의의（χ2=9.235，P ＜0.05）。조중잉치료조적불량임신결국발생솔、신생인불량결국발생솔급영인감염HIV솔여만잉치료조상비，차이균무통계학의의（P＞0.05）。결론임신합병HIV감염적환자，기임신결국급신생인예후여환자개시HAART적시간밀절상관，잉기채용HAART치료자현저우우산전치료자화미치료자，차HAART대태인적생장발육미견명현불량영향。
Objective To investigate the effects and time of interventions to prevent HIV motherto- child transmission. Methods Total of 126 pregnant women infected with HIV from January 2010 to June 2013 in our hospital were divided into three groups according to the time of antiretroviral therapy, including pregnancy-treated group, prenatal-treated group and un-treated group. Moreover, pregnancy-treated group was divided into early-pregnancy-treated group and late-pregnancy-treated group. All patients were given triple highly active antiretroviral therapy (HAART), safety delivery, artificial feeding and other integrated intervention measures. Adverse pregnancy outcomes, newborn’s adverse outcomes and effects of motherinfant block were analyzed, respectively. Results The rate of adverse pregnancy outcomes in pregnancytreated group (3.95%, 3/74) was significantly lower than prenatal-treated group (20.00%, 8/45) and un-treated group (42.86%, 3/7) (χ2 = 14.448, P < 0.05). The rate of newborn’s adverse outcomes in pregnancy-treated group (20.00%, 8/45) was also significantly lower than prenatal-treated group (22.22%, 10/45) and un-treated group (50.00%, 3/6) (χ2 = 8.742, P < 0.05). Among 82 cases of survived infants followed-up, no HIV infection in pregnancy-treated group. While, the infection rate of infants in prenatal-treated group (9.68%, 3/31) was evidently lower than un-treated group (33.33%, 1/3) (χ2 = 9.235, P < 0.05). Furthermore, there was no significant differences in the rate of adverse pregnancy outcomes, newborn’s adverse outcomes and motherto- child transmission in early-pregnancy-treated group and late-pregnancy-treated group. Conclusions Pregnancy outcomes and newborn’s prognosis in HIV-infected mother treated during pregnancy were better than those prenatal-treated or un-treated, which are closely related to the time of starting HAART. HAART seems to have not obvious side effects on newborn’s growth and development.