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目的研究乙型肝炎病毒(HBV)母婴传播情况及其影响因素,为乙肝防治工作提供依据。方法从上海市浦东新区4家医疗机构中招募445名HBV表面抗原(HBsAg)阳性产妇开展流行病学问卷调查,分别采集母亲外周血和新生儿脐带血检测乙肝血清学指标及HBV DNA滴度。新生儿脐带血HBsAg阳性与HBV DNA阳性者定义为新生儿HBV阳性。新生儿均按国家规定注射疫苗,对104名新生儿开展出生后随访到7月龄,采集血样进行乙肝血清学与HBV DNA滴度检测,7月龄婴儿HBsAg阳性定义为儿童HBV突破免疫感染。结果 HBsAg阳性产妇所生新生儿HBV阳性率为8.0%。HBsAg和HBV e抗原(HBeAg)双阳性产妇的新生儿HBV阳性率高于HBsAg单阳性产妇的新生儿(26.7%vs 1.8%,P<0.05);HBV DNA大于106copies/mL产妇的新生儿HBV阳性率高于HBV DNA小于106copies/mL产妇的新生儿(23.6%vs 2.3%,P<0.05)。产后7个月,婴儿突破免疫感染率为3.8%,其母亲均为HBsAg和HBeAg双阳性者。结论母体HBeAg阳性与HBV DNA高浓度是新生儿HBV阳性的主要危险因素,并可能导致新生儿免疫失败。
Objective To study the status of maternal-to-infant transmission of hepatitis B virus (HBV) and its influencing factors so as to provide evidence for the prevention and control of hepatitis B. Methods A total of 445 HBsAg positive mothers were recruited from 4 medical institutions in Shanghai Pudong New Area for epidemiological survey. Serum HBV DNA and hepatitis B virus (HBV) serum were collected from peripheral blood of maternal and neonatal cord blood respectively. Neonatal cord blood HBsAg positive and HBV DNA positive were defined as neonatal HBV positive. Newborns were vaccinated according to national regulations. 104 newborns were followed up to 7 months after birth. Blood samples were collected for hepatitis B serology and HBV DNA titer test. HBsAg positive in 7-month-old infants was defined as breakthrough in children with HBV infection. Results The positive rate of HBV in neonates born to HBsAg positive mothers was 8.0%. The positive rate of HBV in neonates with HBsAg and HBV e antigen (HBeAg) double positive mothers was higher than that of HBsAg single positive mothers (26.7% vs 1.8%, P <0.05); HBV DNA of more than 106copies / mL Rates were higher in neonates with HBV DNA less than 106 copies / mL of mothers (23.6% vs 2.3%, P <0.05). Seven months after birth, the infant exceeded the immunocompromized rate of 3.8%, and both mothers were HBsAg and HBeAg-positive. Conclusion Maternal HBeAg positive and high HBV DNA levels are the major risk factors for neonatal HBV infection and may lead to neonatal immune failure.