背景:乙型肝炎构成了重大的全球公共卫生挑战,母婴传播(MTCT)是乙型肝炎病毒(HBV)传播的主要方法。中国的HBV感染率是亚洲最高的,它承担着全球最大的负担。
目的:本研究旨在通过分析银川市孕妇及其新生儿乙型肝炎的患病率,批判性地评估现有的预防MTCT的局部策略和拟议的潜在增强措施。
方法:从2017年1月至2021年12月,收集了37,557份产前筛查记录。其中,947名孕妇谁检测阳性乙肝表面抗原(HBsAg)接近分娩和他们的960新生儿被纳入HBV暴露组,而29名检测阴性的孕妇及其30名新生儿被纳入HBV非暴露组。母亲外周血和新生儿脐带血HBV标志物使用最小绝对收缩和选择操作(LASSO)回归分析,逻辑回归,卡方检验,t检验,和U测试。此外,为了进一步评估脐带血HBsAg阳性的诊断价值,我们对103例脐带血HBsAg检测呈阳性的婴儿进行了额外的随访研究.
结果:孕妇中HBV的患病率为2.5%(947/37,557),呈逐年下降趋势(χ²4=19.7;P=.001)。从2018年到2020年,只有33.0%(35/106)的合格孕妇接受了抗病毒药物治疗。使用LASSO回归筛选与脐带血HBsAg阳性相关的危险因素(当log[λ]达到最小值-5.02),选择了5个系数为非零的变量,包括母体乙型肝炎e抗原(HBeAg)状态,孕产妇乙型肝炎核心抗体(HBcAb)状态,母体HBVDNA载量,交货方式,和新生儿出生体重。通过单变量和多变量逻辑回归,剖宫产分娩(调整后比值比[aOR]0.52,95%CI0.31-0.87),母体HBeAg阳性(AOR2.05,95%CI1.27-3.33),低母体病毒载量(aOR2.69,95%CI1.33-5.46),和高母体病毒载量(aOR2.69,95%CI1.32-5.51)被发现与脐带血HBsAg阳性密切相关。在额外的后续研究中,61名婴儿成功完成随访,只有2人被发现感染HBV。这两个婴儿的母亲都有可检测的HBVDNA水平,应该接受标准的抗病毒治疗。乙型肝炎表面抗体(HBsAb)阳性率和滴度测试的结果表明,随着疫苗接种后间隔的增加,接种疫苗的婴儿的免疫力逐渐下降。
结论:脐带血HBV标志物检测的临床相关性仅限于目前的MTCT预防措施。强调有关乙型肝炎的公共教育的重要性以及加强产后随访以预防MTCT的重要性。
BACKGROUND: Hepatitis B poses a significant global public health challenge, with mother-to-child transmission (MTCT) being the primary method of hepatitis B virus (HBV) transmission. The prevalence of HBV infection in China is the highest in Asia, and it carries the greatest burden globally.
OBJECTIVE: This study aims to critically evaluate the existing local strategies for preventing MTCT and the proposed potential enhancements by analyzing the prevalence of hepatitis B among pregnant women and their neonates in Yinchuan.
METHODS: From January 2017 to December 2021, 37,557 prenatal screening records were collected. Among them, 947 pregnant women who tested positive for hepatitis B surface antigen (HBsAg) near delivery and their 960 neonates were included in an HBV-exposed group, while 29 pregnant women who tested negative and their 30 neonates were included in an HBV-nonexposed group. HBV markers in maternal peripheral blood and neonatal cord blood were analyzed using the least absolute shrinkage and selection operator (LASSO) regression, logistic regression, chi-square test, t-test, and U-test. Additionally, to further evaluate the diagnostic value of HBsAg positivity in cord blood, we conducted an additional follow-up study on 103 infants who tested positive for HBsAg in their cord blood.
RESULTS: The prevalence of HBV among pregnant women was 2.5% (947/37,557), with a declining trend every year (χ²4=19.7; P=.001). From 2018 to 2020, only 33.0% (35/106) of eligible pregnant women received antiviral medication treatment. Using LASSO regression to screen risk factors correlated with HBsAg positivity in cord blood (when log [λ] reached a minimum value of -5.02), 5 variables with nonzero coefficients were selected, including maternal hepatitis B e-antigen (HBeAg) status, maternal hepatitis B core antibody (HBcAb) status, maternal HBV DNA load, delivery method, and neonatal birth weight. Through univariate and multivariate logistic regression, delivery by cesarean section (adjusted odds ratio [aOR] 0.52, 95% CI 0.31-0.87), maternal HBeAg positivity (aOR 2.05, 95% CI 1.27-3.33), low maternal viral load (aOR 2.69, 95% CI 1.33-5.46), and high maternal viral load (aOR 2.69, 95% CI 1.32-5.51) were found to be strongly associated with cord blood HBsAg positivity. In the additional follow-up study, 61 infants successfully completed the follow-up, and only 2 were found to be infected with HBV. The mothers of both these infants had detectable HBV DNA levels and should have received standard antiviral therapy. The results of the hepatitis B surface antibody (HBsAb) positivity rate and titer test indicated a gradual decline in the immunity of vaccinated infants as the interval after vaccination increased.
CONCLUSIONS: The clinical relevance of HBV marker detection in cord blood is restricted within the current prevention measures for MTCT. There is an emphasis on the significance of public education regarding hepatitis B and the reinforcement of postnatal follow-up for the prevention of MTCT.