| 温海秀,张芳,王婷,王斌,王雪飞,许喜喜,付振东,郭健,张临瑞,高怡,汪波,王素萍.HBsAg阳性母亲HBeAg状态和分娩方式对HBV宫内传播的影响及交互作用[J].中华流行病学杂志,2016,37(6):791-795 |
| HBsAg阳性母亲HBeAg状态和分娩方式对HBV宫内传播的影响及交互作用 |
| Effects related to HBeAg status and mode of delivery as well as the interactions on intrauterine transmission among HBsAg-positive mothers |
| 收稿日期:2015-11-04 出版日期:2016-06-14 |
| DOI：10.3760/cma.j.issn.0254-6450.2016.06.010 |
| 中文关键词: 乙型肝炎病毒宫内传播 乙型肝炎e抗原 分娩方式 交互作用 |
| 英文关键词: HBV intrauterine transmission Hepatitis B e antigens Delivery mode Interaction |
| 基金项目:国家自然科学基金(81072341) |
| 作者 | 单位 | E-mail | | 温海秀 | 030001 太原, 山西医科大学流行病学教研室 | | | 张芳 | 030001 太原, 山西医科大学流行病学教研室 | | | 王婷 | 030001 太原, 山西医科大学流行病学教研室 | | | 王斌 | 030001 太原, 山西医科大学流行病学教研室 | | | 王雪飞 | 030001 太原, 山西医科大学流行病学教研室 | | | 许喜喜 | 030001 太原, 山西医科大学流行病学教研室 | | | 付振东 | 030001 太原, 山西医科大学流行病学教研室 | | | 郭健 | 030001 太原, 山西医科大学流行病学教研室 | | | 张临瑞 | 030001 太原, 山西医科大学流行病学教研室 | | | 高怡 | 030001 太原, 山西医科大学毒理学教研室 | | | 汪波 | 030001 太原市第三人民医院妇产科 | | | 王素萍 | 030001 太原, 山西医科大学流行病学教研室 | spwang88@163.com |
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| 中文摘要: |
| 目的 了解HBsAg阳性母亲HBeAg状态与分娩方式对新生儿HBV宫内传播的影响及交互作用。方法 采用病例对照研究的方法,选择2011年7月至2013年1月在太原市第三人民医院妇产科分娩的344对HBsAg阳性孕妇及其新生儿,收集其一般人口学特征及分娩情况等资料,采用电化学发光法(ECLIA)和荧光定量聚合酶链反应(FQ-PCR)分别检测母亲及新生儿血清HBV标志物与HBV DNA,根据新生儿是否有HBV宫内传播分为病例组(42例)和对照组(302例)。采用单因素χ2检验和非条件logistic回归分析,探讨母亲HBeAg状态和分娩方式对HBV宫内传播的影响及交互作用。结果 344例HBsAg阳性母亲新生儿HBV宫内传播率为12.21%(42/344),母亲HBeAg阳性和阴性两组新生儿HBV宫内传播率分别为18.52%(30/162)和6.59%(12/182),阴道产和剖宫产两组新生儿HBV宫内传播率分别为22.22%(34/153)和4.19%(8/191)。非条件logistic回归分析显示,HBeAg阳性母亲所生新生儿发生HBV宫内传播的风险是HBeAg阴性母亲所生新生儿的3.003倍(OR=3.003,95%CI:1.368~6.593),分娩方式为阴道产时新生儿发生HBV宫内传播的风险是剖宫产的7.333倍(OR=7.333,95%CI:3.108~17.302)。母亲HBeAg状态和分娩方式存在相加交互作用,其超额相对危险度(RERI)、交互作用归因比(AP)和交互作用指数(SI)分别为14.229(95%CI:-8.479~36.938)、0.587(95%CI:0.271~0.903)和2.579(95%CI:1.100~6.047),但不存在相乘交互作用(OR=1.084,95%CI:0.720~1.632)。结论 母亲HBeAg阳性和阴道产可能是新生儿HBV宫内传播的危险因素,母亲HBeAg状态与分娩方式存在相加交互作用。建议HBeAg阳性母亲行剖宫产的方式结束分娩。 |
| 英文摘要: |
| Objective To investigate the relationship between HBeAg status, mode of delivery and intrauterine transmission of the HBsAg-positive mothers as well as their interactions. Methods A total of 344 HBsAg-positive pregnant women and their infants were enrolled in this study. The mothers were recruited from the Third People's Hospital of Taiyuan, from July 2011 to January 2013. Serum HBV-M and HBV DNA were measured using the electro-chemiluminescence immune-assay (ECLIA) kits and fluorescene quantitative polymerase chain reaction (FQ-PCR) assay, respectively. Univariate analysis and unconditional logistic regression analysis were used to explore the risk factors on intrauterine transmission. Results Among 344 neonates born to HBsAg-positive mothers, 42 were validated as HBV intrauterine transmitted, with the rate of intrauterine transmission as 12.21% (42/344). The rates of intrauterine transmission among HBeAg-positive and HBeAg-negative mothers were 18.52% (30/162) and 6.59% (12/182), respectively. The rates of intrauterine transmission were 22.22% (34/153) and 4.19% (8/191) in the groups of vaginal birth or caesarean delivery, respectively. Results from unconditional logistic regression analysis showed that after adjusting the confounding factors, HBeAg-positive mothers (OR=3.003, 95%CI:1.368-6.593) and vaginal birth (OR=7.333, 95%CI:3.108-17.302) might serve as the risk factors for the HBV intrauterine transmission. Data from the interaction analysis showed that there were additive interactions[relative excess risk due to interaction (RERI) as 14.229; the attributable proportion (AP) due to interaction as 0.587; the synergy index (SI) as 2.579] and multiplicative interaction (OR=1.084, 95%CI:0.720-1.632) between HBeAg status and the modes of delivery. Conclusion Vaginal birth and HBeAg-positive might serve as the risk factors for HBV intrauterine transmission. There also appeared additive interactions between HBeAg status and the mode of delivery. |
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