| Objective:To explore the effects of maternal infection status,delivery methods,neonatal gender,feeding methods,whether the mother received immunotherapy,whether the mother has a family history of hepatitis B,and placental phenotype,and other factors on the mother-to-child transmission of HBV,and evaluate the Hepatitis B Vaccine and Hepatitis B Immunoglobulin(HBIG)combined with active and passive immunity blocks the effect of mother-to-child transmission of HBV in order to increase the success rate of mother-to-infant blockade in our hospital and to guide mother-to-infant blockade work,Provide theoretical basis for the blocking and control of viral hepatitis B in our hospital and even in our city.Method:A total of 149 pregnant women with HBsAg(+)were enrolled in the Affiliated Hospital of Yan'an University from October 2016 to May 2017.The 151 newborn infants were immunized with active and passive(hepatitis B vaccine+HBIG)according to the Chinese 0-1-6 procedure and followed up to July to 12 months of age.The use of chemiluminescent microparticle immunoassay(CMIA)to detect hepatitis B virus serum markers(HBVM)in peripheral blood,neonatal umbilical cord blood(or peripheral blood),6-month-old,7-to 12-month-old infants before childbirth-Qualitative and quantitative levels of HBsAg,anti-HBs(HBsAb),HBeAg,anti-HBe(HBeAb)and anti-HBc(HBcAb);determination of HBV DNA using PCR;measurement of the length of placental long axis under pre-natal ultrasound in pregnant women(Length,short axis length(width),thickness,and placental volume were calculated.Result:1.A total of 149 HBsAg(+)-positive pregnant women were included in the study within the study period,and 130 patients met the inclusion criteria and received complete follow-up.A total of 132 neonates were born among the 130 pregnant women.Among them,11 were positive for HBsAg at birth,and the positive rate was8.33%(11/132).One case was positive after the follow-up and the positive rate was0.76%(1/132).There were 0 anti-HBs positive cases at birth and 114 positive cases at the end of follow-up.The positive rate was 88.36%(114/132).2.Univariate analysis for the rate of mother-to-child transmission of HBV showed that the mother had positive HBeAg(X~2=15.867,P<0.001),the mother had HBV DNA positive(X~2=4.473,P=0.034),and the mother had HBV DNA copy?106copies/ml(X~2=62.095,P<0.001),the mother HBsAg titer>2500IU/ml(P<0.001)were statistically significant(P<0.05).The other factors were not statistically significant(P>0.05);the two factors with P<0.1 in the univariate analysis of the four factors with statistically significant differences and general data(negative second-trimester sexual behavior?3 times(X~2=3.163,P=0.075).The mother had a family history of hepatitis B(X~2=3.692,P=0.055).Multivariate logistic analysis was used to determine that mothers were HBeAg positive,maternal HBV DNA positive,and HBV DNA copies?10~6copies/ml,P Values<0.05,with significant statistical differences.The OR values are 4.191,1.121,and 257.216,respectively.3.In the analysis of placental phenotypes,the mother-to-infant transmission positive group was compared with the negative group.The length and volume of the placenta were smaller than the latter,and the difference was statistically significant(P<0.05).There was no statistical difference between the two widths(P>0.05).4.Univariate analysis of infant anti-HBs positivity rate:Sexual behavior during the second trimester?3 times(X~2=4.243,P=0.039),mother has a family history of hepatitis B(X~2=7.656,P=0.006),mother HBeAg positive(X~2=4.587,P=0.032),maternal HBV DNA positive(X~2=9.119,P=0.003),maternal HBV DNA copy?10~6copies/ml(X~2=11.261,P=0.001),maternal HBsAg titers>2500 IU/ml(X~2=63.298,P<0.001)was statistically significant(P<0.05),and other factors were not statistically significant(P>0.1);P<0.1 were included in logistic multivariate analysis,and only mothers were found.There was a significant difference between the HBsAg>2500IU/ml group(P<0.05)and the OR value was 0.005.Conclusion:1.The maternal HBeAg positive,HBV DNA positive and HBV DNA copy?10~6copies/ml are independent risk factors for neonatal HBV mother-to-child transmission.2.The anti-HBs positivity rate of infants showed an upward trend during the follow-up period,and the currently used combined immunotherapy has a significant effect,and the mother's HBsAg>2500 IU/ml is an independent risk factor influencing the infant anti-HBs positive transformation.3.HBV infection can alter the placental morphology and it is more pronounced in placental positive mother-to-infant transmission.The placenta length and volume of positive mother-to-child transmission are smaller than those of mother-to-child transmission.Then the placenta pattern can reflect the possibility of mother-to-child transmission of HBV to a certain extent,and it can even predict whether it has been infected during the placenta.4.HBV intrauterine infection can not be judged by the indicators at birth,should be within 24h after birth,before co-immunization,umbilical blood or peripheral blood HBsAg and(or)HBV DNA positive,until the completion of the whole process of active and passive co-immunization 1 The persistence of positive results after the month is defined as intrauterine infection of HBV. |
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