深圳市孕妇乙肝感染状况分析及乙肝母婴阻断效果评价
发布时间:2018-01-23 13:23
本文关键词: 乙肝感染 孕妇 新生儿 母婴传播 出处:《郑州大学》2017年硕士论文 论文类型:学位论文
【摘要】:研究背景乙型病毒性肝炎(Hepatitis B,HB)是全球主要的公共卫生问题之一。全球范围内约有20亿人感染过HBV,其中约有3.5亿人成为慢性感染者。母婴传播是HBV感染的主要原因。30%~50%的HBV携带者是由于HBV母婴传播导致的宫内感染或幼儿期感染。如果孕妇HBsAg和HBeAg都为阳性,母婴传播率可高达90%,感染时年龄越小,变成慢性携带者的概率越高。因此,阻断母婴传播对控制我国乙肝流行及预防HBV相关肝病具有重要的意义。目前,对孕产妇进行乙肝感染状况筛查,对新生儿接种乙肝疫苗,同时对乙肝表面抗原阳性母亲的新生儿接种免疫球蛋白是预防和控制乙肝母婴传播的主要措施。深圳市自2002年开始向所有新生儿免费提供三针乙肝疫苗注射,2010年开始每年对全市接近20万孕妇进行HBsAg筛查,并对阳性孕妇的新生儿给予HBIG和乙肝疫苗联合免疫阻断措施。对深圳市实施预防和控制乙肝母婴阻断措施之后孕妇的乙肝感染状况和乙肝母婴阻断措施的效果尚未进行评价。研究目的通过对深圳市孕妇开展乙肝感染免费检测,了解深圳市孕妇乙肝感染状况;比较流动人口和户籍人口孕妇乙肝感染状况;对新生儿乙肝母婴阻断措施的实施效果进行评价,为进一步改进和完善深圳市预防和控制乙肝母婴传播项目提供参考依据。对象与方法对象:2011年1月1日至2015年12月31日期间深圳市所有到助产机构进行孕期检查的孕妇,以及2015年所有乙肝表面抗原阳性孕妇所生新生儿。方法:对深圳市所有到助产机构进行孕期检查的孕妇在知情同意的前提下,进行乙肝两对半检测,检测结果由首诊医生录入“深圳市妇幼保健管理系统”中的乙肝专项模块;社区健康服务中心预防接种医生督促阳性孕妇在儿童完成三针乙肝疫苗接种后,让其带儿童到上级医院进行乙肝两对半检测,并将检测结果录入上述系统,于2015年抽取一定数量阳性孕妇所生儿童进行干预效果评价。从系统中将2011~2015年深圳市全市孕妇基本信息及乙肝血清学检测结果、HBsAg阳性孕妇的新生儿相关信息导出,利用Excel2010和SPSS21.0软件进分析。用χ2和Fisher确切概率法检验变量间的差异性,运用二元logistic回归分析户籍、年龄等因素对HBsAg、抗-HBs的影响。所有统计学检验均为双侧检验,P0.05为差异具有统计学意义。研究结果深圳市2011~2015年间实际共检测乙肝五项孕妇为732783例。其中流动人口孕妇635554例(86.73%),户籍人口孕妇有97229例(13.27%)。深圳市孕妇HBs Ag阳性率、抗-HBs阳性率、HBeAg阳性率、抗-HBe阳性率和抗-HBc阳性率分别为8.66%、49.27%、3.10%、12.97%、22.27%;HBsAg阳性孕妇的HBeAg阳性率、抗-HBe阳性率分别为30.25%、53.51%;流动人口孕妇HBsAg阳性率(8.83%)高于户籍人口孕妇(7.62%),抗-HBs阳性率(46.03%)低于户籍人口孕妇(70.41%)。流动人口和孕次较多是乙肝感染的危险因素,文化程度高是其保护因素。2015年HBsAg阳性孕妇所生新生儿完成乙肝两对半检测者共6376例,乙肝疫苗首针及时接种率为97.09%,HBsAg、抗-HBs阳性率分别为0.87%、95.65%.研究结论1.深圳市孕妇HBsAg阳性率(8.66%)及HBsAg与HBeAg双阳性孕妇占比仍较高,实施乙肝母婴阻断,具有重要的公共卫生意义。2.外来流动人口孕妇HBsAg阳性率高于深圳市户籍人口孕妇,应重视乙肝母婴阻断项目的公共卫生均等化。3.深圳市乙肝母婴阻断首针乙肝疫苗和HBIG接种率均较高,干预效果较好,且效果优于全国。
[Abstract]:The research background of hepatitis B virus (Hepatitis B HB) is one of the main public health problem in the world. There are about 2 billion people infected with HBV worldwide, of which about 350 million people become chronically infected..30%~50% maternal transmission is the main reason for HBV infection of HBV carriers is infected by mother to child transmission of HBV intrauterine lead to infection or early childhood. If HBsAg and HBeAg are positive for pregnant women, maternal transmission rate can be as high as 90%. The infection age is smaller, the higher the probability to become chronic carriers. Therefore, blocking mother to child transmission plays an important role in the control of China's hepatitis B epidemic and prevention of HBV related liver disease. At present, the maternal HBV infection the status of newborn screening, hepatitis B vaccine, and neonatal vaccination immunoglobulin on hepatitis B surface antigen positive mothers are the main measures of prevention and control of mother to child transmission of hepatitis B in Shenzhen city since 2002. To provide free of charge to all three neonatal hepatitis B vaccine injection needle, the beginning of the year in 2010 HBsAg screening for the nearly 200 thousand pregnant women, and the pregnant women with positive neonates treated with immune HBIG and hepatitis B vaccine in blocking measures. The implementation of the prevention and control of hepatitis B in pregnant women with maternal and infant blocking measures after hepatitis B infection and hepatitis B PMTCT measures not evaluation of Shenzhen city. The purpose of the study through the free detection of hepatitis B infection on pregnant women in Shenzhen city to carry out, understand the HBV infection status of pregnant women in Shenzhen city; comparison of floating population and household population of pregnant women with hepatitis B infection; the treatment effect on neonatal hepatitis B vertical evaluation block, for further improving and perfecting the city of Shenzhen to provide reference for the prevention and control of hepatitis B mother to child transmission project. Objects and methods: during the period from January 1, 2011 to December 31, 2015 in Shenzhen City All the midwifery institutions pregnancy checks for pregnant women, and the 2015 all HBsAg positive newborns. Methods: all Shenzhen city to midwifery institutions during pregnancy examination of pregnant women informed consent under the premise of two semi hepatitis B testing, hepatitis B special module detection result by the first doctor into the Shenzhen City Maternal and child health management system in the community health service center; vaccination doctors urge positive pregnant women completed three doses of hepatitis B vaccine in children, let the children take to the hospital for a higher level of two semi hepatitis B testing, and test results of the system input, in 2015 for a certain number of positive pregnant women born children from intervention. The detection results of pregnant women in Shenzhen city and the basic information of hepatitis B serological system, 2011~2015, information derived from neonatal HBsAg positive pregnant women, Using Excel2010 and SPSS21.0 software analysis. The difference between 2 and Fisher exact probability test between the variables in X, with two yuan logistic regression analysis of residence, age and other factors on the HBsAg effects of anti -HBs. All statistical tests were two-sided test, P0.05 the difference has statistical significance. The research results of Shenzhen city during 2011~2015 the actual total of five pregnant women for the detection of hepatitis B in 732783 cases. 635554 cases of floating population of pregnant women (86.73%), household population of pregnant women has 97229 cases (13.27%). The positive rate of Ag in pregnant women in Shenzhen City, HBs, anti -HBs positive rate, HBeAg positive rate, the positive rate of anti -HBe and anti -HBc positive rate were 8.66%, 49.27%, 3.10%, 12.97%, 22.27%; the positive rate of HBeAg HBsAg positive pregnant women, the positive rate of anti -HBe were 30.25%, 53.51%; the positive rate of HBsAg in pregnant women of floating population (8.83%) is higher than that of the household population of pregnant women (7.62%), anti -HBs positive rate (46.03%) lower than the household population. Women (70.41%). The floating population and more times of pregnancy is a risk factor for hepatitis B infection, high educational level is a protective factor for.2015 in HBsAg positive newborns completed two semi hepatitis B testing 6376 cases, timely first dose of hepatitis B vaccine inoculation rate was 97.09%, HBsAg, anti -HBs positive rate was 0.87%. Conclusion 95.65%. 1. pregnant women in Shenzhen City, the positive rate of HBsAg (8.66%) and HBsAg and HBeAg positive pregnant women the proportion is still high, the implementation of the hepatitis B PMTCT, with the positive rate of public health significance of migrant pregnant women.2. HBsAg important than Shenzhen household population of pregnant women, should pay attention to hepatitis B PMTCT project of public health equalization in Shenzhen.3. hepatitis B PMTCT first dose of hepatitis B vaccine and vaccination rate of HBIG was higher and the intervention effect is good, and the effect is better than that of the country.
【学位授予单位】:郑州大学
【学位级别】:硕士
【学位授予年份】:2017
【分类号】:R714.251
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