摘要
目的探讨乙型肝炎病毒(HBV)感染产妇血清HBV-DNA载量和乙型肝炎病毒e抗原(HBeAg)表达状况对母乳喂养安全性的影响,为HBV感染产妇母乳喂养的选择提供参考。方法选取2017年1月-2018年10月于攀枝花市妇幼保健院内住院分娩的HBV感染产妇200例为研究对象,在分娩前空腹状态抽取静脉血、在分娩后24 h内采集乳汁,检测血清HBV标志物、血清及乳汁HBV-DNA载量,分析结果。结果HBeAg阳性患者93例、阴性者107例。147例产妇血清HBV-DNA阳性,阳性率为73.50%,104例产妇乳汁阳性,阳性率为52.00%。产妇血清HBeAg阳性时血清及乳汁HBV-DNA载量均高于HBeAg阴性产妇(P<0.05);产妇血清HBeAg阳性时血清及乳汁HBV-DNA阳性率分别为89.25%(83/93)、69.89%(65/93)均高于HBeAg阴性产妇(P<0.001);产妇血清HBV-DNA载量<500 copies/ml、500~10~5 copies/ml、≥10~5 copies/ml时乳汁HBV-DNA阳性率分别为0.00%、62.61%、100.00%,比较差异有统计学意义(P<0.001);产妇血清HBV-DNA载量<500 copies/ml、500~10~5 copies/ml、≥10~5 copies/ml时乳汁HBV-DNA载量分别为(312.43±34.56)copies/ml、(5456.88±672.11)copies/ml、(8231.34±712.11)copies/ml,比较差异有统计学意义(P<0.001)。74例产妇分娩新生儿进行了母乳喂养,在6个月后检测显示6例婴幼儿HBV阳性,阳性率为8.11%。血清HBV阳性的母乳喂养婴幼儿母亲产时血清及母乳HBV载量均高于HBV阴性的母乳喂养婴幼儿母亲的水平(P<0.001);HBV阳性的母乳喂养婴幼儿母亲均表现为产时血清及母乳HBV-DNA阳性,阳性率为100.00%,HBV阴性的母乳喂养婴幼儿母亲产时血清及母乳HBV-DNA阳性率均为22.06%,差异有统计学意义(P<0.001)。结论HBV感染产妇血清HBV-DNA载量和HBeAg表达状况对产妇乳汁中HBV-DNA水平存在影响,血清HBV-DNA载量≥10~5 copies/m时乳汁中HBV-DNA水平较高,不适宜母乳喂养,血清HBV-DNA载量500~10~5 copies/ml时需要检测乳汁HBV-DNA水平,若检出则不适宜母乳喂养,HBeAg阳性与阴性时均应行血清及乳汁HBV-DNA检测,根据血清及乳汁HBV-DNA水平决定是否母乳喂养。
OBJECTIVE To explore the effects of HBV-DNA load and Hepatitis B e antigen(HBeAg)expression in maternals serum of hepatitis B virus(HBV)infection on the safety of breastfeeding,so as to provides reference for the selection of breastfeeding for HBV-infected women.METHODS A total of 200 cases of HBV-infected women who were hospitalized in Panzhihua Maternal and Child Health Hospital form Jan.2017 to Oct.2018 were selected as study subjects.The venous blood was taken in the fasting state before delivery,and the milk was collected within 24 hours after delivery to detected serum HBV markers and HBV-DNA load of serum and milk.RESULTS There were 93 cases(46.50%)of HBeAg positive patients and 107 cases(63.50%)of HBeAg negative patients.Serum HBV-DNA were positive in 147 maternals,with the positive rate of 73.50%,and milk was positive in 104 maternals,with the positive rate of 52.00%.Serum and milk HBV-DNA load of HBeAg-positive maternals were higher than those of HBeAg-negative maternals(P<0.05).The positive rates of serum and milk HBV-DNA of HBeAg-positive maternals were 89.25%(83/93)and 69.89%(65/93),respectively,which were significantly higher than those of HBeAg-negative maternals(P<0.001).The HBV-DNA-positive rates in milk,were 0.00%,62.61%and 100.00%,respecively,when serum HBV-DNA load was<500 copies/ml,500-10~5 copies/ml and≥10~5 copies/m,and the difference was significant(P<0.001).The HBV-DNA load in milk were(312.43±34.56)copies/ml,(5456.88±672.11)copies/ml,and(8231.34±712.11)copies/ml,respecively,when serum HBV-DNA was load<500 copies/ml,500-10~5 copies/ml and≥10~5copies/m,the difference was significant(P<0.001).74 cases of materal delivery newborns were breasefed,and after 6 months,6 cases of infants were positive for HBV,with a positive rate of 8.11%.Serum and breast milk HBV-DNA load of the mothers with serum HBV-positive breast-fed infants were significantly higher than that of the mothers with HBV-negative breast-fed infants(P<0.001).The HBV-DNA positive rate in both serum and breast milk of HBV-positive mothers were 100.00%,while the HBV-DNA positive rate in serum and breast milk of HBV-DNA negative mothers were 22.06%,the difference was significant(P<0.001).CONCLUSION Serum HBV-DNA load and HBeAg expression in maternal serum of HBV infection affect the level of HBV-DNA in maternal milk.When the serum HBV-DNA load were≥10~5 copies/ml,the level of HBV-DNA in the milk will be higher,which is not suitable for breastfeeding.When the serum HBV-DNA load were 500-10~5 copies/ml,it is necessary to detect the HBV-DNA level of milk.If it is detected,it is not suitable for breastfeeding.Serum and milk HBV-DNA should be tested when HBeAg positive or negative,and determination of whether breast-feeding should be based on serum and milk HBV-DNA level.
作者
张丽
罗汝琼
王力
孙霞
刘雪琴
ZHANG Li;LUO Ru-qiong;WANG Li;SUN Xia;LIU Xue-qin(Panzhihua Maternal and Child Health Hospital,Panzhihua,Sichuan 617000,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2020年第3期414-418,共5页
Chinese Journal of Nosocomiology
基金
四川省科技计划基金资助项目(2016S38901)。
