CAJ | 학술논문

目的探讨不同喂养方式对乙型肝炎病毒(hepatitis B virus,HBV)母婴传播的影响. 方法 2010年12月1 8日至2012年6月26日,在首都医科大学附属北京地坛医院分娩的慢性HBV感染产妇中,纳入足月单胎妊娠者,根据产妇意愿分为母乳喂养组和人工喂养组.每组根据孕妇分娩前血清HBV-DNA载量进一步分为3个亚组:HBV-DNA阴性(＜5×10 2拷贝/ml)、低病毒载量(≥5×102～＜1×106拷贝/ml)和高病毒载量(≥1×106拷贝/ml).母乳喂养组共199例,3个亚组各73、62和64例;人工喂养组共210例,3个亚组各74、62和74例.新生儿出生2h内和15～30 d注射乙肝免疫球蛋白,并按“0、1、6月”方案正规接种重组酵母乙肝疫苗.采用荧光定量聚合酶链反应技术检测HBV-DNA.采用微粒子化学发光法检测HBV血清学标记物.比较母乳喂养组与人工喂养组的基本情况,及婴儿1月龄和7月龄时的免疫应答情况、7月～2岁时的感染情况.采用独立样本t检验、秩和检验、X2检验、Fisher精确概率法进行统计分析. 结果 HBV-DNA阴性、低病毒载量和高病毒载量的母乳喂养组与人工喂养组的乙肝e抗原阳性率分别为12.3％(9/73)与5.4％(4/74)、37.1％(23/62)与51.6％(32/62)、96.9％(62/64)与95.9％(71/74),差异均无统计学意义(P值均＞ 0.05).409例婴儿中,70例7月龄时未复查,但均在1～2岁时进行复查.HBV-DNA阴性、低病毒载量和高病毒载量的母乳喂养组与人工喂养组婴儿7月龄时乙肝表面抗体阳性率分别为98.4％(61/62)与100.0％(63/63)、98.2％(54/55)与98.2％(56/57)、95.7％(44/46)与92.9％(52/56),差异均无统计学意义(P值均＞0.05).母乳喂养组与人工喂养组婴儿感染率分别为3.0％(6/199)与2.4％(5/210).HBV-DNA阴性组无婴儿感染;低病毒载量、高病毒载量的母乳喂养组与人工喂养组婴儿感染率分别为0.0％(0/62)与1.6％(1/62)、9.4％(6/64)与5.4％(4/74),差异均无统计学意义(P值均＞0.05). 结论在联合免疫的前提下,慢性HBV感染产妇采用母乳喂养不增加婴儿感染风险. 目的探討不同餵養方式對乙型肝炎病毒(hepatitis B virus,HBV)母嬰傳播的影響. 方法 2010年12月1 8日至2012年6月26日,在首都醫科大學附屬北京地罈醫院分娩的慢性HBV感染產婦中,納入足月單胎妊娠者,根據產婦意願分為母乳餵養組和人工餵養組.每組根據孕婦分娩前血清HBV-DNA載量進一步分為3箇亞組:HBV-DNA陰性(＜5×10 2拷貝/ml)、低病毒載量(≥5×102～＜1×106拷貝/ml)和高病毒載量(≥1×106拷貝/ml).母乳餵養組共199例,3箇亞組各73、62和64例;人工餵養組共210例,3箇亞組各74、62和74例.新生兒齣生2h內和15～30 d註射乙肝免疫毬蛋白,併按“0、1、6月”方案正規接種重組酵母乙肝疫苗.採用熒光定量聚閤酶鏈反應技術檢測HBV-DNA.採用微粒子化學髮光法檢測HBV血清學標記物.比較母乳餵養組與人工餵養組的基本情況,及嬰兒1月齡和7月齡時的免疫應答情況、7月～2歲時的感染情況.採用獨立樣本t檢驗、秩和檢驗、X2檢驗、Fisher精確概率法進行統計分析. 結果 HBV-DNA陰性、低病毒載量和高病毒載量的母乳餵養組與人工餵養組的乙肝e抗原暘性率分彆為12.3％(9/73)與5.4％(4/74)、37.1％(23/62)與51.6％(32/62)、96.9％(62/64)與95.9％(71/74),差異均無統計學意義(P值均＞ 0.05).409例嬰兒中,70例7月齡時未複查,但均在1～2歲時進行複查.HBV-DNA陰性、低病毒載量和高病毒載量的母乳餵養組與人工餵養組嬰兒7月齡時乙肝錶麵抗體暘性率分彆為98.4％(61/62)與100.0％(63/63)、98.2％(54/55)與98.2％(56/57)、95.7％(44/46)與92.9％(52/56),差異均無統計學意義(P值均＞0.05).母乳餵養組與人工餵養組嬰兒感染率分彆為3.0％(6/199)與2.4％(5/210).HBV-DNA陰性組無嬰兒感染;低病毒載量、高病毒載量的母乳餵養組與人工餵養組嬰兒感染率分彆為0.0％(0/62)與1.6％(1/62)、9.4％(6/64)與5.4％(4/74),差異均無統計學意義(P值均＞0.05). 結論在聯閤免疫的前提下,慢性HBV感染產婦採用母乳餵養不增加嬰兒感染風險.
목적 탐토불동위양방식대을형간염병독(hepatitis B virus,HBV)모영전파적영향. 방법 2010년12월1 8일지2012년6월26일,재수도의과대학부속북경지단의원분면적만성HBV감염산부중,납입족월단태임신자,근거산부의원분위모유위양조화인공위양조.매조근거잉부분면전혈청HBV-DNA재량진일보분위3개아조:HBV-DNA음성(＜5×10 2고패/ml)、저병독재량(≥5×102～＜1×106고패/ml)화고병독재량(≥1×106고패/ml).모유위양조공199례,3개아조각73、62화64례;인공위양조공210례,3개아조각74、62화74례.신생인출생2h내화15～30 d주사을간면역구단백,병안“0、1、6월”방안정규접충중조효모을간역묘.채용형광정량취합매련반응기술검측HBV-DNA.채용미입자화학발광법검측HBV혈청학표기물.비교모유위양조여인공위양조적기본정황,급영인1월령화7월령시적면역응답정황、7월～2세시적감염정황.채용독립양본t검험、질화검험、X2검험、Fisher정학개솔법진행통계분석. 결과 HBV-DNA음성、저병독재량화고병독재량적모유위양조여인공위양조적을간e항원양성솔분별위12.3％(9/73)여5.4％(4/74)、37.1％(23/62)여51.6％(32/62)、96.9％(62/64)여95.9％(71/74),차이균무통계학의의(P치균＞ 0.05).409례영인중,70례7월령시미복사,단균재1～2세시진행복사.HBV-DNA음성、저병독재량화고병독재량적모유위양조여인공위양조영인7월령시을간표면항체양성솔분별위98.4％(61/62)여100.0％(63/63)、98.2％(54/55)여98.2％(56/57)、95.7％(44/46)여92.9％(52/56),차이균무통계학의의(P치균＞0.05).모유위양조여인공위양조영인감염솔분별위3.0％(6/199)여2.4％(5/210).HBV-DNA음성조무영인감염;저병독재량、고병독재량적모유위양조여인공위양조영인감염솔분별위0.0％(0/62)여1.6％(1/62)、9.4％(6/64)여5.4％(4/74),차이균무통계학의의(P치균＞0.05). 결론 재연합면역적전제하,만성HBV감염산부채용모유위양불증가영인감염풍험.
Objective To explore the effect of different feeding patterns on mother-to-child transmission of hepatitis B virus (HBV).Methods Chronic HBV-infected puerperae,who gave birth to a single baby at term in Beijing DiTan Hospital from December 18,2010 to June 26,2012,were recruited and separated into breast-feeding group and formula-feeding group according to the mother's will.Each group was then divided into three subgroups based on matemal serum HBV-DNA load before delivery:HBV-DNA negative subgroup (＜ 5 × 102 copies/ml),low viral load subgroup (≥ 5 × 102-＜ 1.0 × 106 copies/ml) and high viral load subgroup (≥ 1.0 × 106 copies/ml).A total of 199 patients in breast-feeding group were divided into three subgroups,separately including 73,62 and 64 patients,while a total of 210 patients in formula-feeding group into three subgroups,including 74,62 and 74 patients.Newborns were injected with Hepatitis B hyper-immune globulin (HBIG) within 2 h after birth and at 15 to 30 days,followed by the routine injection of recombinant yeast derived Hepatitis B vaccine in accordance with the scheme of "0,1,6 months".HBV-DNA was determined by fluorescence quantitative polymerase chain reaction,while serological markers of HBV by microsome chemiluminescence method.Comparisons were made between the breast-feeding and formula-feeding group on maternal background information,immune responses of the infants at one-month and seven-month old,the infectious status when they were between seven-month to two-year old.Statistical analysis was made with independent sample t-test,rank-sum test,x2 test and Fisher's exact test.Results The HBeAg positive rates of puerperae in the three subgroups (HBV-DNA negative,low viral load and high viral load) among women of the breast-feeding group were 12.3％ (9/73),37.1％ (23/62) and 96.9％(62/64),respectively,while 5.4％ (4/74),51.6％ (32/62) and 95.9％ (71/74) among the formula-feeding group.There was no significant difference between breast-feeding group and formula-feeding group (all P ＞ 0.05).Seventy of the 409 infants missed the follow-up at seven-month old,but returned between one to two years old.The anti-HBs positive rates of the three subgroups in infants of the breast-feeding group at seven-month old were 98.4％ (61/62),98.2％ (54/55) and 95.7％ (44/46),while 100.0％ (63/63),98.2％ (56/57) and 92.9％ (52/56) in the formula-feeding group (all P ＞ 0.05).The infection rate of infants in the breast-feeding group and the formula-feeding group were 3.0％ (6/199) and 2.4％ (5/210) at seven-month to two-year old.Notably,infected infants was identified in HBV-DNA negative subgroup in neither the breast-feeding group nor the formula-feeding group,while 0.0％ (0/62) and 9.4％ (6/64) of infection rate were reported in low viral load and high viral load subgroups of the breast-feeding group and 1.6％ (1/62) and 5.4％ (4/74) of the formula-feeding group (both P ＞ 0.05).Conclusion With combined immunization,breast-feeding in chronic HBV infected mothers does not increase the risk of infantile infection.