中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
Chinese Journal of Perinatal Medicine
2015年
11期
823-827
,共5页
冯静%李洁%刘景丽%朱海燕%朱湘玉%周乙华%胡娅莉
馮靜%李潔%劉景麗%硃海燕%硃湘玉%週乙華%鬍婭莉
풍정%리길%류경려%주해연%주상옥%주을화%호아리
乙型肝炎病毒%乙型肝炎%传染性疾病传播,垂直%羊膜腔穿刺术
乙型肝炎病毒%乙型肝炎%傳染性疾病傳播,垂直%羊膜腔穿刺術
을형간염병독%을형간염%전염성질병전파,수직%양막강천자술
Hepatitis B virus%Hepatitis B%Infectious disease transmission,vertical%Amniocentesis
目的 探讨羊膜腔穿刺是否增加乙型肝炎病毒(hepatitis B virus,HBV)母婴传播的风险. 方法 回顾性调查2010年1月至2013年12月在南京大学医学院附属鼓楼医院行羊膜腔穿刺的40例乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)阳性孕妇及其子女,其中3例(7.5％)孕妇乙型肝炎e抗原(hepatitis B e antigen,HBeAg)阳性.随访时询问孕妇抗病毒治疗史,记录儿童预防措施,并采集儿童外周血,检测HBV血清标记物.同时检测同期采集的、于-80℃保存的HBsAg阳性孕妇的共48例羊水标本中的HBV标记物.采用x2检验或Fisher精确概率法进行统计分析. 结果 40例孕妇行羊膜腔穿刺时平均年龄(31.5±5.5)岁(21～41岁),平均孕周(21.2±1.6)周(18.4～24.9周).穿刺指征主要为唐氏综合征筛查高风险(26例、65.0％)和高龄(4例、10.0％),14例(35.0％)孕妇经胎盘穿刺.所有孕妇穿刺前均未接受抗病毒治疗,新生儿出生时均正规接种乙型肝炎疫苗和使用乙型肝炎免疫球蛋白.获得随访且保存羊水标本的28例孕妇中,2例(7.1％) HBsAg阳性,其中1例(3.6％) HBV DNA同时阳性.40例获随访的子代中,男性23例(57.5％),平均年龄(2.0±1.0)岁(7个月～4岁).HBsAg阳性孕妇羊水HBsAg和HBV DNA阳性率大于HBsAg阴性者[4.7％(2/43)与3/5,x2=14.705;0/43与2/5,x2=17.948;P值均＜0.05].37例HBsAg阳性而HBeAg阴性孕妇的子代无一例HBsAg阳性,乙型肝炎核心抗体(hepatitis B core antibody,抗HBc)亦均阴性,另3例HBsAg和HBeAg同时阳性孕妇的子代HBsAg和抗-HBc均阴性.子代乙型肝炎表面抗体阳性率90.0％(36/40). 结论 对HBeAg阴性孕妇,羊膜腔穿刺不增加其子代感染HBV的风险,经胎盘穿刺亦不增加HBV母婴传播的风险.对HBeAg阳性孕妇,羊膜腔穿刺是否增加HBV母婴传播尚需进一步研究.羊水HBsAg或HBV DNA阳性不能诊断为宫内感染.
目的 探討羊膜腔穿刺是否增加乙型肝炎病毒(hepatitis B virus,HBV)母嬰傳播的風險. 方法 迴顧性調查2010年1月至2013年12月在南京大學醫學院附屬鼓樓醫院行羊膜腔穿刺的40例乙型肝炎錶麵抗原(hepatitis B surface antigen,HBsAg)暘性孕婦及其子女,其中3例(7.5％)孕婦乙型肝炎e抗原(hepatitis B e antigen,HBeAg)暘性.隨訪時詢問孕婦抗病毒治療史,記錄兒童預防措施,併採集兒童外週血,檢測HBV血清標記物.同時檢測同期採集的、于-80℃保存的HBsAg暘性孕婦的共48例羊水標本中的HBV標記物.採用x2檢驗或Fisher精確概率法進行統計分析. 結果 40例孕婦行羊膜腔穿刺時平均年齡(31.5±5.5)歲(21～41歲),平均孕週(21.2±1.6)週(18.4～24.9週).穿刺指徵主要為唐氏綜閤徵篩查高風險(26例、65.0％)和高齡(4例、10.0％),14例(35.0％)孕婦經胎盤穿刺.所有孕婦穿刺前均未接受抗病毒治療,新生兒齣生時均正規接種乙型肝炎疫苗和使用乙型肝炎免疫毬蛋白.穫得隨訪且保存羊水標本的28例孕婦中,2例(7.1％) HBsAg暘性,其中1例(3.6％) HBV DNA同時暘性.40例穫隨訪的子代中,男性23例(57.5％),平均年齡(2.0±1.0)歲(7箇月～4歲).HBsAg暘性孕婦羊水HBsAg和HBV DNA暘性率大于HBsAg陰性者[4.7％(2/43)與3/5,x2=14.705;0/43與2/5,x2=17.948;P值均＜0.05].37例HBsAg暘性而HBeAg陰性孕婦的子代無一例HBsAg暘性,乙型肝炎覈心抗體(hepatitis B core antibody,抗HBc)亦均陰性,另3例HBsAg和HBeAg同時暘性孕婦的子代HBsAg和抗-HBc均陰性.子代乙型肝炎錶麵抗體暘性率90.0％(36/40). 結論 對HBeAg陰性孕婦,羊膜腔穿刺不增加其子代感染HBV的風險,經胎盤穿刺亦不增加HBV母嬰傳播的風險.對HBeAg暘性孕婦,羊膜腔穿刺是否增加HBV母嬰傳播尚需進一步研究.羊水HBsAg或HBV DNA暘性不能診斷為宮內感染.
목적 탐토양막강천자시부증가을형간염병독(hepatitis B virus,HBV)모영전파적풍험. 방법 회고성조사2010년1월지2013년12월재남경대학의학원부속고루의원행양막강천자적40례을형간염표면항원(hepatitis B surface antigen,HBsAg)양성잉부급기자녀,기중3례(7.5％)잉부을형간염e항원(hepatitis B e antigen,HBeAg)양성.수방시순문잉부항병독치료사,기록인동예방조시,병채집인동외주혈,검측HBV혈청표기물.동시검측동기채집적、우-80℃보존적HBsAg양성잉부적공48례양수표본중적HBV표기물.채용x2검험혹Fisher정학개솔법진행통계분석. 결과 40례잉부행양막강천자시평균년령(31.5±5.5)세(21～41세),평균잉주(21.2±1.6)주(18.4～24.9주).천자지정주요위당씨종합정사사고풍험(26례、65.0％)화고령(4례、10.0％),14례(35.0％)잉부경태반천자.소유잉부천자전균미접수항병독치료,신생인출생시균정규접충을형간염역묘화사용을형간염면역구단백.획득수방차보존양수표본적28례잉부중,2례(7.1％) HBsAg양성,기중1례(3.6％) HBV DNA동시양성.40례획수방적자대중,남성23례(57.5％),평균년령(2.0±1.0)세(7개월～4세).HBsAg양성잉부양수HBsAg화HBV DNA양성솔대우HBsAg음성자[4.7％(2/43)여3/5,x2=14.705;0/43여2/5,x2=17.948;P치균＜0.05].37례HBsAg양성이HBeAg음성잉부적자대무일례HBsAg양성,을형간염핵심항체(hepatitis B core antibody,항HBc)역균음성,령3례HBsAg화HBeAg동시양성잉부적자대HBsAg화항-HBc균음성.자대을형간염표면항체양성솔90.0％(36/40). 결론 대HBeAg음성잉부,양막강천자불증가기자대감염HBV적풍험,경태반천자역불증가HBV모영전파적풍험.대HBeAg양성잉부,양막강천자시부증가HBV모영전파상수진일보연구.양수HBsAg혹HBV DNA양성불능진단위궁내감염.
Objective To investigate whether amniocentesis may increase the risk for mother-tochild transmission of hepatitis B virus (HBV).Methods Totally 40 children born to HBV-infected mothers who had amniocentesis performed in Nanjing Drum Tower Hospital, Nanjing University Medical School from January 2010 to December 2013, were followed up and screened for HBV markers.Amniotic fluid samples were collected and stored at-80 ℃ were tested for HBV markers.Among the 40 carrier mothers, three (7.5％) were hepatitis B e antigen (HBeAg)-positive.Relevant data such as antiviral history, administration of hepatitis B vaccine and hepatitis B immunoglobulin (HBIG) in infants were collected.Chi-square test or Fisher's exact test was used for statistical analysis.Results The mothers were 21-41 years old, with a mean age of (31.5±5.5) years at the time of amniocentesis and mean gestational age of (21.2± 1.6) weeks (18.4-24.9 weeks).Indications for amniocentesis were mainly abnormal maternal serum alpha-fetoprotein levels (65.0％, 26/40)and maternal age over 35 years (10.0％, 4/40).None of the mothers received antiviral therapy and 14 (35.0％)underwent transplacental amniocentesis.Among 28 cases who had a store of amniotic fluid sample and were followed-up, one (7.1％) was positive for both hepatitis B surface antigen (HBsAg) and HBV DNA, and another was positive for HBsAg only.The average age of 40 children at follow-up was (2.0± 1.0) years (seven months to four years old), among which 23 were boys and 17 were girls.All of them received hepatitis B vaccine and HBIG.Positive rate of HBsAg and HBV DNA in HBeAg(+) mothers are higher than those in HBeAg(-) mothers [4.7％(2/43) vs 3/5, x2=14.705;0/43 vs 2/5, x2=17.948;both P ＜ 0.05].Thirty-seven children born to HBsAg(+)/HBeAg(-) mothers were negative for both HBsAg and hepatitis B core antibody (anti-HBc), and the other three born to HBsAg(+)/HBeAg(+) mothers were also negative for HBsAg and anti-HBc.Additionally, the positive rate of hepatitis B surface antibody in children was 90.0％ (36/40).Conclusions For those HBsAg(+)/HBeAg(-) mothers, amniocentesis does not elevate the risk for mother-to-child transmission of HBV, even performed transplacentally.However, further studies are needed for HBeAg-positive mothers.HBsAg or HBV DNA positive in amniotic fluid should be diagnosed as intrauterine infection of HBV.
