摘要
目的探讨乙肝孕妇一孩母婴阻断失败的原因及二孩妊娠阻断效果和母婴结局,评价妊娠期抗病毒治疗阻断乙型肝炎母婴传播对儿童生长发育的影响。方法选取2017年2月至2019年2月南京中医药大学附属南京医院产科常规产检的34例HBV感染经产妇。HBV感染孕妇一孩妊娠时均未抗病毒治疗为一孩组;二孩妊娠时均在妊娠中晚期开始抗病毒治疗为二孩组,比较两次妊娠期合并症及并发症的发生率。两次分娩新生儿分为新生儿一孩组及新生儿二孩组,比较一般情况、患病情况及生长发育。结果34例孕妇两次妊娠期间均为HBeAg阳性,分娩一孩前平均HBV-DNA为(2.27±1.95)×10^(8)IU/mL,二孩妊娠后孕妇平均HBV-DNA水平为(2.43±2.15)×10^(8)IU/mL。二孩组分娩前口服抗病毒药物孕妇病毒载量均下降,平均下降至(1.98±6.23)×10^(3)IU/mL。二孩组孕妇剖宫产率高于一孩组孕妇(P=0.005)。一孩组孕妇出现妊娠合并症、产时并发症发生率与二孩组差异无统计学意义(P>0.05)。新生儿一孩组新生儿出生后规范的乙肝疫苗接种率为70.59%(24/34),规范的乙肝免疫球蛋白接种率为50%(17/34)。新生儿二孩组新生儿乙肝疫苗及免疫球蛋白接种率和及时率高于新生儿一孩组(P<0.05)。两组新生儿出生缺陷、生长发育差异没有统计学意义(P>0.05)。结论高病毒载量孕妇孕期抗病毒治疗可有效降低病毒载量,联合新生儿免疫接种可以减少新生儿乙肝病毒感染的发生。妊娠期抗病毒治疗不会增加围生期不良事件和产时并发症的发病率,也不影响新生儿的生长发育。
Objective This study was aimed to investigate the causes of mother-to-child blocking failure in the first fetus of hepatitis B virus(HBV)infected mothers,the prevention of mother-to-child transmission(MTCT)during second pregnancy and maternal-infant outcomes.We evaluated the influence of antiviral therapy during pregnancy for preventing MTCT on children's growth and development.Methods Among HBV infected multiparas who underwent routine prenatal examinations at the Obstetrics Department of Nanjing University of Chinese Medicine Affiliated Nanjing Hospital from February 2017 to February 2019,we screened 34 multiparas whose first child failed in the prevention of MTCT.HBV infected multiparas were grouped as first pregnancy group without antiviral therapy and second pregnancy group with antiviral therapy in the second and third trimester.The incidence of pregnancy complications and intrapartum complications during the two pregnancies were compared.Neonates were grouped as first pregnancy neonates and second pregnancy neonates to compare basic conditions,morbidity,growth and development.Results All the 34 pregnant women were HBeAg positive during two pregnancies and the average HBVDNA before first delivery was(2.27±1.95)×10^(8)U/mL.Average HBVDNA level was(2.43±2.15)×10^(8)IU/ml during second pregnancy.Viral loads before delivery all decreased to(1.98±6.23)×10^(3)U/mL on average during second pregnancy with antiviral therapy.Cesarean delivery rate of second pregnancy group was higher than that of first pregnancy group.There was no statistical differences in the incidence of the adverse events perinatally and the intrapartum complications(P>0.05).The standard hepatitis B vaccine and immunoglobin coverage rate after birth of the first newborns was 70.59%(24/34)and 50%(17/34).The coverage rate and timely of hepatitis B vaccine and immunoglobin was higher in second pregnancy group(P<0.05).Conclusion Antiviral treatment during pregnancy can effectively reduce the viral load of pregnant women with high viral load,and combined with neonatal immunization can reduce the incidence of neonatal hepatitis B virus infection.Antiviral therapy during pregnancy does not increase the incidence of perinatal adverse events and complications during labor,and not affect the growth and development of newborns.
作者
陈艳
陈超
江红秀
周冠伦
和沁园
韩国荣
CHEN Yan;CHEN Chao;JIANG Hongxiu;ZHOU Guanlun;HE Qinyuan;HAN Guorong(Department of Obstetrics and Gynecology,The Second Hospital of Nanjing,Nanjing University of Chinese Medicine,Nanjing 210003,Jiangsu,China)
出处
《医学研究与战创伤救治》
CAS
北大核心
2024年第4期352-356,共5页
Journal of Medical Research & Combat Trauma Care
基金
国家科技部“十三五”重大专项(2017ZX10201201-001-002,2017ZX10201201-002-001)。
关键词
母婴阻断
乙肝感染
抗病毒
生长发育
prevention of mother-to-child transmission
HBV infection
antiviral therapy
growth and development
