羊膜穿刺术在HBs抗原阳性母亲垂直传播乙型肝炎的危险

StephenW

Risk of Vertical Transmission of Hepatitis B after Amniocentesis in HBs Antigen-Positive Mothers

    Wei Yi a,
    Calvin Q. Pan b, Corresponding author contact information, E-mail the corresponding author, E-mail the corresponding author,
    Jianzhen Hao a,
    Yuhong Hu a,
    Min Liu a,
    Li Li a,
    Dongzhu Liang a

    a Department of Obstetrics and Gynecology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
    b Division of Gastroenterology, Department of Medicine, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA


Abstract
Background

Despite appropriate immunoprophylaxis, HBV vertical transmission (VT) occurs in 5-10% of infants born to HBs-antigen (HBsAg) + mothers. We investigated whether amniocentesis increases the risk of transmission.
Methods

We performed a case-control study on infants who were born to HBsAg + mothers without antiviral exposure and completed appropriate immunization. Infants born to mothers with amniocentesis were compared to those without amniocentesis to assess VT rates, which were defined by the percentage of infants with HBsAg positivity when they were 7−12 months old.
Results

Of the 642 consecutive infants enrolled, 63 infants with amniocentesis were compared with 198 matched infants selected from the remaining 579 infants without amniocentesis. There was a higher VT rate in infants with amniocentesis than in those without amniocentesis (6.35% vs. 2.53%; p = 0.226). Maternal HBV DNA levels before amniocentesis were further stratified to < 500 copies/mL, 500-6.99 log10 copies/mL, and ⩾ 7 log10 copies/mL for subset analyses. There were no significant differences in the VT rates between the amniocentesis group and the control group if the maternal HBV DNA levels were < 6.99 log10 copies/mL. However, a significantly higher VT rate was observed in the amniocentesis group vs. the control group if the maternal HBV DNA ⩾ 7 log10 copies/mL (50% vs. 4.5%, respectively, p=0.006). According to baseline value risk analyses, performing amniocentesis on highly viremic mothers was a risk factor for HBV transmission (OR = 21.3, 95% CI: 2.960-153.775).
Conclusions

Amniocentesis performed on HBsAg+ mothers with HBV DNA ⩾ 7 log10 copies/mL significantly increased the frequency of VT. HBsAg+ women who plan to have amniocentesis should be evaluated for the risk of VT and stratified according to their HBV DNA levels. Further prospective studies are warranted to verify our findings.

StephenW

垂直传播乙型肝炎的羊膜穿刺术在后HBs抗原阳性母亲的危险

    魏毅一，
    卡尔文问：潘B，通讯作者的联系信息，电子邮件通讯作者，电子邮件通讯作者，
    鉴真浩一，
    于洪胡一，
    刘敏一，
    李力一，
    东渚良一

    妇产科首都医科大学附属一系，北京地坛医院，北京，中国
    消化内科，医学系，纽约大学Langone医学中心，纽约大学医学院，纽约，纽约州，美国的B组


摘要
背景

尽管相应的免疫预防，乙肝病毒垂直传播（ VT ）发生在出生乙型肝炎表面抗原（HBsAg ）阳性母亲的婴儿的5-10％。我们研究了羊膜穿刺术是否会增加传染的危险。
方法

我们进行了对谁是天生的HBsAg阳性母亲没有抗病毒风险，并完成了相应的免疫接种婴幼儿病例对照研究。出生与羊膜穿刺术婴儿的母亲进行了比较，那些没有羊膜穿刺术，以评估VT率，这是由婴儿与HBsAg阳性率的百分比划分，当他们7-12个月大。
结果

在642个连续婴幼儿就读，其中63婴儿用羊膜穿刺术从剩余的579名婴幼儿无羊膜穿刺术选择的198匹配的婴儿进行了比较。有较高的VT率婴幼儿羊膜穿刺术比那些没有羊膜穿刺术（ 6.35 ％对2.53 ％，P = 0.226 ） 。产妇HBV DNA水平之前，羊膜穿刺术是进一步分层，以< 500拷贝/ ml ， 500-6.99 log10拷贝/毫升，而⩾ 7 log10拷贝/毫升的亚组分析。有羊膜穿刺组与对照组之间在VT率没有显著差异，如果孕产妇HBV DNA水平分别为< 6.99 log10拷贝/毫升。然而，一个显著更高​​的VT率观察羊膜穿刺组与对照组比较，如果产妇血清HBV DNA ⩾ 7 log10拷贝/毫升（ 50 ％对4.5 ％ ，P均= 0.006） 。根据基线值风险分析，对高病毒血症母亲进行羊膜穿刺术是对乙肝病毒传播（ OR = 21.3 ， 95 ％CI ： 2.960-153.775 ）的危险因素。
结论

羊膜穿刺术对HBsAg阳性母亲进行乙肝病毒DNA ⩾ 7 log10拷贝/ mL的显著增加VT的频率。乙肝表面抗原阳性妇女谁计划有羊膜穿刺术应根据自己的HBV DNA水平进行评估，对VT的风险和分层。进一步的前瞻性研究来验证我们的研究结果。

咬牙硬挺

感谢分享，建议共享到生儿育女板块

StephenW

咬牙硬挺 发表于 2013-11-26 20:53
感谢分享，建议共享到生儿育女板块

好主意。因为翻译的不是很好，所以将不会到生儿育女板块发帖，因为可能会混淆读者。我已通知版主.