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目的:探讨乙型肝炎病毒(HBV)携带母亲的新生儿母婴感染的易患因素。方法:回顾性分析HBs Ag阳性孕妇及其子女,结合住院病历及随访调查,记录母亲分娩方式、哺乳方式、儿童疫苗接种等资料,并对母亲和子女采血检测HBV血清学标志。结果:250例随访儿童中,238例出生24 h内接种了第1针乙肝疫苗,179例24 h内注射了乙肝免疫球蛋白(HBIG);儿童HBs Ag阳性4例,阳性率1.6%。其中HBe Ag阳性母亲48例的子女HBs Ag阳性4例,阳性率为8.3%明显高于孕期HBe Ag阴性母亲的子女HBs Ag阳性率为0.0%(P<0.01)。经剖宫产和阴道分娩的子女HBs Ag阳性率分别为2.1%(3/140)和0.9%(1/110)(P>0.05),人工喂养儿童HBs Ag阳性率4.8%(4/83)高于母乳喂养(P<0.05),可能与人工喂养组母亲HBe Ag阳性率53.0%(44/83)明显高于母乳喂养组2.4%(4/167)有关(P<0.01)。结论:母亲HBe Ag阳性是发生HBV母婴传播的危险因素,新生儿正规免疫预防后剖宫产和人工喂养并不降低HBV母婴感染的风险。因此,不能将剖宫产分娩作为减少HBV母婴传播的手段,并应该鼓励HBs Ag阳性产妇进行母乳喂养。
Objective: To investigate the risk factors for neonatal maternal-neonatal infection of hepatitis B virus (HBV) in mothers. Methods: The HBs Ag positive pregnant women and their children were retrospectively analyzed. The records of maternal delivery mode, breastfeeding method and children vaccination were recorded according to the inpatient records and follow-up surveys. HBV serological markers were detected by blood sampling in mothers and children. Results: Of the 250 follow-up children, 238 were vaccinated with the first dose of hepatitis B vaccine within 24 hours of birth and 179 were injected with hepatitis B immunoglobulin (HBIG) within 24 hours. The positive rate of HBs Ag in children was 1.6%. Among them, 48 cases of HBeAg-positive mothers had HBs Ag positive in 4 cases, the positive rate was 8.3%, which was significantly higher than that of HBs Ag negative mothers in pregnancy (0.0%, P <0.01). The positive rates of HBsAg in children who were delivered by cesarean section and vaginal delivery were 2.1% (3/140) and 0.9% (1/110) respectively (P> 0.05), and those in artificially fed children were 4.8% (4/83) Higher than that of breastfeeding (P <0.05), which may be related to the positive rate of HBe Ag of 53.0% (44/83) of mothers in artificial feeding group and 2.4% (4/167) in breastfeeding group (P <0.01). Conclusion: Maternal HBe Ag positive is a risk factor for transmission of mother-to-child transmission of HBV. Neonatal cesarean section and artificial feeding after regular immunization do not reduce the risk of HBV infection. Therefore, cesarean section delivery can not be used as a means of reducing mother-to-child transmission of HBV, and HBsAg-positive mothers should be encouraged to breastfeed.