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目的:探讨分娩方式对乙型肝炎病毒(HBV)母婴垂直传播的影响。方法:将HBs Ag阳性孕妇及其婴儿211例,按不同分娩方式分为阴道分娩组(126例)和选择性剖宫产组(85例),两组新生儿均完成主被动联合免疫接种,检测孕妇及婴儿出生24h内、7个月、12个月龄时的外周静脉血的HBV血清学标志物、HBV DNA水平,比较两组婴儿HBV母婴阻断效果。结果:婴儿出生24h内选择性剖宫产组的HBs Ag、HBV DNA阳性率低于阴道分娩组(10.59%vs 21.43%,P<0.05)。婴儿7个月龄、12个月龄时,两组的HBs Ag、HBV DNA阳性率比较,差异无统计学意义(P>0.05)。孕妇HBe Ag阴性、HBV DNA≤10~(11)copies/L时,阴道分娩组和选择性剖宫产组的HBV母婴阻断失败率比较,差异无统计学意义(P>0.05)。孕妇HBe Ag阳性、HBV DNA>10~(11)copies/L时,选择性剖宫产组的HBV母婴阻断失败率明显低于阴道分娩组(3.45%vs 23.81%,5.25%vs 33.33%,P<0.05)。结论:分娩方式与HBV母婴传播阻断有关,当孕妇HBe Ag阳性或HBV DNA>10~(11)copies/L时,选择性剖宫产可能降低乙肝母婴垂直传播几率。
Objective: To investigate the effect of mode of delivery on the vertical transmission of hepatitis B virus (HBV) in infants and mothers. Methods: A total of 211 HBsAg-positive pregnant women and their infants were divided into vaginal delivery group (n = 126) and selective cesarean section group (n = 85) according to different modes of delivery. Both newborns completed active and passive immunization, Serum markers of HBV and HBV DNA in peripheral blood of pregnant women and infants born within 24 hours, 7 months and 12 months of age were detected. Results: The positive rate of HBs Ag and HBV DNA in the cesarean section was lower than that in the vaginal delivery group (10.59% vs 21.43%, P <0.05). There were no significant differences in the positive rates of HBs Ag and HBV DNA between the two groups at 7 months and 12 months of age (P> 0.05). When HBe Ag was negative in pregnant women and HBV DNA ≤10 ~ (11) copies / L, there was no significant difference in failure rate between mother and child in vaginal delivery group and selective cesarean section (P> 0.05). HBeAg positive pregnant women, HBV DNA> 10 ~ (11) copies / L, selective cesarean section HBV maternal and infant block failure rate was significantly lower than vaginal delivery group (3.45% vs 23.81%, 5.25% vs 33.33% , P <0.05). Conclusion: The mode of delivery is related to the interruption of mother-to-child transmission of HBV. When pregnant women have positive HBeAg or HBV DNA> 10 ~ (11) copies / L, selective cesarean section may reduce the chance of vertical transmission of hepatitis B virus.