文章摘要
张荣莲,王梅颖,陈起燕,修晓燕,任坤海,邱丽茵,黄欣欣.父母双方乙型肝炎病毒感染垂直传播的危险因素研究[J].中华流行病学杂志,2012,33(12):1283-1287
父母双方乙型肝炎病毒感染垂直传播的危险因素研究
Study on the risk factors related vertical transmission of HBV positive couples to their infant
收稿日期:2012-06-08  出版日期:2014-09-18
DOI:10.3760/cma.j.issn.0254-6450.2012.12.020
中文关键词: 乙型肝炎病毒;垂直传播;危险因素
英文关键词: Hepatitis B virus;Vertical transmission;Risk factors
基金项目:福建省自然科学基金(2011J01124);福建省医学创新课题(2011-CXB一17)
作者单位E-mail
张荣莲 福建省妇幼保健院, 福州 350001
福建医科大学研究生教育学院 
wpxzrl@163.com 
王梅颖 福建省妇幼保健院, 福州 350001
福建医科大学研究生教育学院 
 
陈起燕 福建省妇幼保健院, 福州 350001  
修晓燕 福建省妇幼保健院, 福州 350001  
任坤海 福建省妇幼保健院, 福州 350001  
邱丽茵 福建省妇幼保健院, 福州 350001  
黄欣欣 福建省妇幼保健院, 福州 350001  
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中文摘要:
      目的 探讨父母双方均为乙型肝炎病毒(HBV)感染者其垂直传播的危险因素及感染率.方法 选择2010年8月至2011年11月在福建省妇幼保健院行产前检查夫妻双方均为HBsAg阳性的46个孕妇家庭及其新生儿为研究对象.分娩时收集新生儿脐带血,进行血清HBV标志物(HBVM)、HBV-DNA检测,以脐带血HBV-DNA载量≥5×102 copies/ml为病例组,此值以下为对照组.结果 新生儿脐带血HBV-DNA阳性率为45.7%(21/46),HBsAg阳性率为34.8%(16/46),HBeAg阳性率为23.9%(11/46);母亲血清HBV-DNA阳性率为52.2%(24/46),HBeAg阳性率为39.1%(18/46);父亲血清HBV-DNA阳性率为69.6% (32/46),HBeAg阳性率为32.6%(15/46).单因素分析表明,孕妇血清HBsAg阳性HBVM不同模式、HBeAg阳性、HBV-DNA阳性和HBV-DNA载量及其配偶血清HBsAg阳性HBVM不同模式、HBeAg阳性、HBV-DNA阳性和HBV-DNA载量为HBV垂直传播的危险因素,x2值分别为8.731、8.414、8.932、9.663、10.823、3.962、13.638、36.501,差异均有统计学意义(P<0.05).多因素分析表明,孕妇血清HBV-DNA阳性及其配偶血清HBV-DNA载量是夫妻双方HBV感染垂直传播的危险因素,OR值及其95%CI分别为17.6(1.3 ~238.4)和3.5(1.6~7.6);夫妻双方血清HBV-DNA载量均与脐带血HBV-DNA载量呈正相关,其血清HBV-DNA载量均>脐带血HBV-DNA载量.随着父母双方血清HBV-DNA载量的升高,新生儿脐带血HBV-DNA载量也逐渐升高,两者存在剂量反应关系;ROC曲线分析表明,孕妇血清HBV-DNA载量为103 copies/ml、其配偶血清HBV-DAN载量在104 copies/ml时预测的敏感性与特异性较高,为预测HBV垂直传播发生的分界点,病例组和对照组新生儿结局差异均无统计学意义(P>0.05);对脐带血HBV-DNA阳性新生儿随访至第7个月时,阴转率为15.0%(3/20).结论 母亲血清HBV-DNA阳性、父亲血清HBV-DNA载量是其亲子HBV垂直传播的危险因素;母亲血清HBV-DNA载量>103 copies/ml、父亲血清HBV-DAN载量>104 copies/ml时,HBV亲子垂直传播的阳性率增加.
英文摘要:
      Objective To explore the risk factors and the rate of HBV vertical transmission from HBsAg-positive couple to their infant.Methods 46 families who had antenatal examination at Fujian Provincial Maternal and Child Health Hospital during August 2010 and November 2011 were chosen as research object.Cord blood was sampled after delivery for HBVM and HBV-DNA quantification.Those with HBV-DNA load ≥5 × 102 copies/ml were involved in the case group while those having <5 × 102 copies/ml were chosen as controls.Results The average positive rate of neonatal cord blood HBV-DNA was 45.7% (21/46),while the positive rates of cord blood HBsAg and HBeAg were 34.8%(16/46) and 23.9% (11/46) respectively.The positive rates of maternal serum HBV-DNA and paternal serum HBV-DNA were 52.2% (24/46) and 69.6% (32/46) respectively,with the positive rate of couple serum HBeAg as 39.1% (18/46) and 32.6%(15/46) respectively.Results from univariate analysis showed that hepatitis B surface markers,serum HBeAg-positive,serum HBV-DNA positive,and serum HBV-DNA load of the couples were risk factors to the HBV vertical transmission(x2=8.731,8.414,8.932,9.663,10.823,3.962,13.638,36.501 ;P<0.05).Data from the multivariate analysis showed that maternal serum HBV-DNA positive and paternal serum HBV-DNA load were risk factors to the HBV vertical transmission [OR= 17.6 (1.3-238.4) ;OR = 3.5 (1.6-7.6)].Serum HBV-DNA loads of the couples were positively correlated with the cord blood HBV-DNA load,while the load levels of the couple' s serum HBV-DNA were higher than cord blood HBV-DNA.There appeared dose-response relationship between couple' s serum HBV-DNA load level and the cord blood HBV-DNA load level.Results from the analysis of ROC curve showed that both maternal serum HBV-DNA load level (103 copies/ml) and paternal serum HBV-DNA load level (104 copies/ml) were demarcation points to better forecast the occurrence of vertical transmission of HBV,because there showed higher sensitivity and specificity for the forecasting process.Neonatal outcomes showed no significant difference between the case group and the control group.The negative conversion rate became 15.0% (3/20) when the HBV-DNA positive infants were followed up for 7 months.Conclusion Both maternal serum HBV-DNA positive and paternal serum HBV-DNA load were risk factors of HBV vertical transmission.When the maternal serum HBV-DNA load appeared >103 copies/ml and paternal serum HBV-DNA load > 104 copies/ml,the rate of HBV vertical transmission would increase.
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