妊娠合并乙肝病毒感染

发布时间：2018-06-09 06:22

本文选题：乙肝病毒 + 妊娠　；参考：《重庆医科大学》2014年硕士论文

【摘要】：乙肝病毒（Hepatitis B virus，HBV）感染一直是威胁人类健康及生命的重要病因，全球大约有4亿名乙肝病毒感染者，其中50%的患者是通过母婴垂直传播（Mother to infant vertical transmission, MTVT）被感染，他们当中超过95%将转为慢性乙型病毒性病毒肝炎（Chronic hepatitis B，CHB）。而同时乙肝病毒感染对妊娠的结局有不良影响（如：妊娠期糖尿病、产前出血、早产、低体重儿等）。对妊娠合并乙肝病毒感染进行全面认识及有效治疗，能显著降低乙肝病毒感染率及妊娠不良结局发生率。乙肝表面抗原（Hepatitis B surface antigen，HBsAg）阳性的孕妇若有较高乙肝病毒基因（Hepatitis B virus Deoxyribonucleic acid，HBV-DNA）水平及肝炎活动［丙氨酸氨基转移酶（Alanine aminotransferase，ALT）2倍正常上限, HBV-DNA105copies/ml)］或伴有严重程度肝纤维化/肝硬化，建议妊娠早期进行抗病毒治疗［1］。在孕28周-30周对乙肝病毒滴度较高（HBV-DNA107copies/ml）孕妇，或既往有HBsAg阳性婴儿分娩史且HBV-DNA106copies/ml的孕妇，，进行抗病毒治疗直到分娩后4周，再根据病情决定是否继续抗病毒治疗。新生儿出生后24小时内应注射高效价乙肝免疫球蛋白（Hepatitis B immune globulin，HBIG）并接种乙肝疫苗，是阻断母婴垂直传播最有效的方式。乙肝病毒感染不能作为选择性剖宫产的主要因素。在没有乳头破裂、出血的孕妇，建议对接受联合免疫的新生儿进行母乳喂养。对于妊娠合并乙肝病毒感染仍有较多有待解决的疑问，如：乙肝病毒是否可以通过父系生殖细胞进行传播、孕早期抗病毒治疗是否安全、孕晚期使用高效价乙肝免疫球蛋白是否能阻断宫内感染等。
[Abstract]:Hepatitis B virus (HBV) infection has been an important cause of human health and life. There are about 400 million people infected with hepatitis B virus, 50% of whom are infected through vertical transmission from mother to child. More than 95 percent of them will be converted to chronic viral hepatitis B virus Chronic hepatitis. At the same time hepatitis B virus infection has adverse effects on the outcome of pregnancy (e.g. gestational diabetes mellitus, prenatal hemorrhage, premature delivery, low birth weight, etc. Comprehensive understanding and effective treatment of pregnancy complicated with hepatitis B virus infection, Hepatitis B surface antigen-HBV-DNA and hepatitis B virus deoxyribonucleic acid nucleic acid DNA (HBV-DNA) level and hepatitis B aminotransferase activity in pregnant women with hepatitis B surface antigen-HBsAg positive were significantly decreased in the presence of hepatitis B virus deoxyribonucleic acid nucleic acid (HBV-DNA) and the activity of hepatitis B aminotransferase (Alanine). Aminotransferase2 times the normal upper limit, HBV-DNA 105 cases / ml] or severe liver fibrosis / cirrhosis, It is recommended that antiviral therapy be carried out in early pregnancy [1]. From 28 weeks to 30 weeks of gestation, pregnant women with high HBV titer (HBV-DNA 107copias / ml), or pregnant women with HBsAg positive infant delivery history and HBV-DNA 106copias / ml, were treated with antiviral therapy until 4 weeks after delivery, and then decided whether to continue antiviral therapy according to their condition. It is the most effective way to block vertical transmission from mother to child by injecting high titer hepatitis B immune globulin (HBIGI) and inoculating hepatitis B vaccine within 24 hours after birth. Hepatitis B virus infection is not a major factor in selective cesarean section. In pregnant women without ruptured nipples and bleeding, breast-feeding of newborns receiving combined immunization is recommended. There are still more questions to be solved about pregnancy with hepatitis B virus infection. Such as: whether hepatitis B virus can be transmitted through paternal germ cells, whether antiviral therapy is safe in early pregnancy and whether high titer hepatitis B immunoglobulin can block intrauterine infection in the third trimester of pregnancy.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.251

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