HBV宫内感染的流行病学研究

发布时间：2018-09-03 20:34

【摘要】：目的研究孕妇人群中HBV的携带率及HBV携带孕妇的新生儿HBV宫内感染率,分析HBV宫内感染的危险因素,评价HBV宫内感染对新生儿发育的影响。方法在产前常规检查中,使用酶联免疫吸附试验检测孕妇的HBV标志物,将HBV携带孕妇作为目标人群。在孕妇产后采集新生儿脐带血检测HBV标志物,按标准方法测量新生儿的体重、身高、头围和胸围。发生HBV宫内感染的新生儿作为病例组,未发生的作为对照组,分析HBV宫内感染的危险因素,比较产前有无HBIG接种史孕妇的新生儿HBV宫内感染率,评估HBV宫内感染的预防效果。采用Z值法评价新生儿的发育状况。结果2002～2004年,共检测了3415名孕妇,HBV携带率为3.34%(114/3415),城镇孕妇HBV携带率(2.91%)低于农村孕妇(5.62%)(x~2=9.23,P0.01);除2例死胎外,在112名HBV携带孕妇所生的112名新生儿中,有33名新生儿发生了HBV宫内感染,感染率为29.46%。两组新生儿的体重Z得分(t=0.21,P=0.832)、身长Z得分(t=1.60,P=0.122)、头围Z得分(t=1.03,P=0.311)和胸围Z得分(t=0.89,P=0.372)差异无统计学意义。单因素分析显示,孕妇HBeAg阳性、阴道流血史、腹痛史、孕妇肝功能、分娩方式、新生儿性别和羊水性状的宫内感染比值比及其95%可信区间分别为2.56(1.05～6.22)、3.29(0.93～7.69)、1.84(0.54～6.27)、0.64(0.27～1.52)、1.38(0.61～3.13)、0.69(0.30～1.56)和1.79(0.76～4.24);多因素分析显示,孕妇HBeAg阳性(OR=3.14 95%CI 1.23～8.04)、阴道流血史(OR=4.47 95%CI 1.18～16.99)与HBV宫内感染有关联;有HBIG接种史的孕妇所生的新生儿HBV宫内感染发生率(13.16%),明显低于无HBIG接种史的孕妇所生的新生儿(37.83%)(x~2=7.36,P0.01)。结论合肥地区孕妇HBV携带率较低,且城镇低于农村;孕妇HBeAg阳性、孕期阴道流血史可能是HBV宫内感染的危险因素,而分娩方式、孕妇肝功能、新生儿性别和羊水污染情况与HBV宫内感染无关;HBV携带的孕妇产前注射HBIG能有效地降低HBV宫内感染的发生
[Abstract]:Objective to study the prevalence of HBV in pregnant women and the intrauterine infection rate of HBV among pregnant women with HBV, analyze the risk factors of HBV intrauterine infection, and evaluate the influence of HBV intrauterine infection on neonatal development. Methods the HBV markers of pregnant women were detected by enzyme linked immunosorbent assay (Elisa) during prenatal routine examination. The pregnant women with HBV were taken as target population. Umbilical cord blood was collected from pregnant women after delivery to detect HBV markers, and the weight, height, head circumference and chest circumference of newborns were measured according to the standard method. The newborns with intrauterine HBV infection were used as case group and control group. The risk factors of intrauterine HBV infection were analyzed. The intrauterine infection rate of newborns with or without HBIG inoculation was compared, and the preventive effect of intrauterine HBV infection was evaluated. The development of newborn was evaluated by Z value method. Results from 2002 to 2004, 3415 pregnant women were tested for HBV carrier rate (3.34%, 114 / 3415), the HBV carrier rate of urban pregnant women (2.91%) was lower than that of rural pregnant women (5.62%) (x29.23 P0.01), except for 2 stillbirths, 33 of 112 newborns born with HBV carriers had intrauterine HBV infection. The infection rate was 29.46%. There was no significant difference in Z score of body weight (t = 0.21), Z score of body length (t = 1.60 ~ 0.122), Z score of head circumference (t = 1.03) and Z score of chest circumference (t = 0.89 / P ~ 0.372) between the two groups, and there was no significant difference between the two groups in the weight Z score (t = 0.21), the body length Z score (t = 1.60), the head circumference Z score (t = 1.03) and the chest circumference Z score (t = 0.372). Univariate analysis showed that pregnant women were positive for HBeAg, history of vaginal bleeding, history of abdominal pain, liver function of pregnant women, and delivery mode. The intrauterine infection ratio and 95% confidence interval of sex and amniotic fluid were 2.56 (1.056.22) 3.29 (0.937.69) 1.84 (0.546.27) 0.64 (0.271.52) 1.38 (0.613.13) 0.69 (0.301.56) and 1.79 (0.764.24) respectively. The incidence of intrauterine HBV infection in pregnant women with HBIG inoculation history (13.16%) was significantly lower than that in pregnant women without HBIG inoculation (37.83%) (x 27.36%, P0.01). The positive rate of HBeAg in pregnant women (OR=3.14 95%CI 1.23 ~ 8.04) and history of vaginal bleeding (OR=4.47 95%CI 1.18 ~ 16.99) were associated with intrauterine infection of HBV, and the incidence of intrauterine HBV infection in newborns of pregnant women with history of HBIG inoculation (13.16%) was significantly lower than that of pregnant women without HBIG inoculation (37.83%). Conclusion the HBV carrying rate of pregnant women in Hefei is lower than that in towns and villages, the positive HBeAg of pregnant women and the history of vaginal bleeding during pregnancy may be the risk factors of intrauterine HBV infection, while the delivery mode and the liver function of pregnant women. Sex and amniotic fluid contamination of newborns have nothing to do with intrauterine HBV infection. Prenatal injection of HBIG into pregnant women with HBV can effectively reduce the incidence of intrauterine HBV infection.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2005
【分类号】：R181.3

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