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我国是乙型肝炎病毒(Hepatitis B virus,HBV)感染的高流行区,HBV感染的育龄期女性是HBV传播的主要传染源,其中大多数育龄期的乙肝女性为乙型肝炎病毒携带状态,因此,乙型肝炎病毒携带孕妇的HBV母婴阻断成了临床愈发关注的问题。实践中,即使HBsAg阳性的孕妇分娩的新生儿接种乙肝疫苗和乙肝免疫球蛋白,仍有5%-10%的新生儿感染HBV,尤其母亲为HBe Ag阳性、高病毒载量者。因此,美国肝病研究学会(AASLD)、欧洲肝病学会(EASL)和英国国立优质卫生和保健研究所(NICE)指南推荐高病毒载量的孕妇在妊娠晚期口服抗病毒药物拉米夫定、替诺福韦、替比夫定进行母婴阻断,减少新生儿感染HBV的机率,但目前乙型肝炎病毒携带孕妇阻断HBV母婴传播的临床管理和预防策略尚未达成共识,尤其是母乳喂养和分娩方式等问题仍存在争议,本文谨从HBsAg筛查、垂直传播的危险因素、阻断方法、分娩方式、母乳喂养等方面进行综述,探讨如何优化管理乙型肝炎病毒携带孕妇,并对未来HBV母婴阻断的研究进行展望。
China is a high endemic area of Hepatitis B virus (HBV) infection. Women of childbearing age who are infected with HBV are the main source of HBV transmission. Most of the women of childbearing age have hepatitis B virus carrying status, therefore , Hepatitis B virus infection in pregnant women with HBV mother and child became more and more attention to the issue of clinical. In practice, between 5% and 10% of newborns are still infected with HBV, even if their mothers are HBeAg-positive and have a high viral load, even though newborns giving birth to HBsAg-positive pregnant women are vaccinated against hepatitis B and hepatitis B immunoglobulins. Therefore, guidelines from the American Association for the Study of the Liver (AASLD), the European Association for the Study of the Liver (EASL), and the National Institute of Health and Well-being (NICE) recommend that women with high viral load should be given an oral antiviral lamivudine, Fu Wei, telbivudine for maternal and infant block, reduce the risk of neonatal HBV infection, but the current hepatitis B virus in pregnant women to prevent HBV mother-to-child transmission of clinical management and prevention strategies have not reached consensus, especially breastfeeding and Delivery mode and other issues are still controversial, this article from the HBsAg screening, vertical transmission of risk factors, methods of blocking, mode of delivery, breastfeeding and other aspects to explore how to optimize the management of hepatitis B virus-carrying pregnant women, and the future of HBV The research of maternal and child occlusion is prospected.