乙型肝炎表面抗原和乙型肝炎e抗原双阳性的乙型肝炎病毒携带产妇进行母乳喂养的安全性

目的探讨乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)和乙型肝炎e抗原(hepatitis B e antigen,HBeAg)双阳性的乙型肝炎病毒(hepatitis B virus,HBV)携带产妇采用母乳喂养对其所生婴儿HBV感染率的影响.方法采用前瞻性队列研究方法,纳入2016年2月至2018年5月在浙江大学医学院附属妇产科医院进行产前检查及分娩的HBsAg和HBeAg双阳性携带HBV产妇及其所生的婴儿各323例,将其分为母乳喂养组和人工喂养组.采用化学发光免疫分析法和聚合酶链反应-荧光探针法,分别检测两组婴儿在出生<24 h及7月龄时的血清HBV标志物和HBV DNA的阳性率.统计学方法采用x2检验.结果最终纳入297例患者,其中母乳喂养组149例,人工喂养组148例.母乳喂养组与人工喂养组婴儿在出生<24 h及7月龄时的HBsAg、抗-HBs、HBeAg、HBV DNA>100 IU/mL的阳性率比较,差异均无统计学意义(均P>0.05).母乳喂养组出生<24 h新生儿抗-HBs阳性率为58.39%(87/149),低于7月龄时的95.97%(143/149);母乳喂养组出生<24 h新生儿HBeAg阳性率为65.10%(97/149),高于7月龄时的13.42%(20/149);差异均有统计学意义(x2=59.75、40.49,均P<0.01).母乳喂养组出生<24 h新生儿的HBsAg和HBV DNA>100 IU/mL阳性率分别为2.01%(3/149)和2.68%(4/149),其7月龄时的HBsAg和HBV DNA>100 IU/mL阳性率分别为2.68%(4/149)和2.68%(4/149),两个时间点比较差异均无统计学意义(均P>0.05).人工喂养组出生<24 h新生儿抗-HBs阳性率为47.97%(71/148),低于7月龄时的95.94%(142/148);人工喂养组出生<24 h新生儿HBeAg阳性率为55.41%(82/148),高于7月龄时的19.59%(29/148);差异均有统计学意义(x2=85.37、39.84,均P<0.01).人工喂养组出生<24h新生儿的HBsAg和HBV DNA>100IU/mL阳性率分别为4.73%(7/148)和1.35%(2/148),其7月龄时的HBsAg和HBV DNA>100 IU/mL阳性率分别为1.35%(2/148)和1.35%(2/148),两个时间点比较差异均无统计学意义(均P>0.05).结论母乳喂养不是增加HBsAg和HBeAg双阳性HBV携带产妇垂直传播风险的决定性因素,建议这类产妇在正规预防的前提下进行母乳喂养.

Maternal breast feeding safety of hepatitis B virus carrying parturient women with hepatitis B surface antigen and hepatitis B e antigen double positive

Objective To explore hepatitis B virus(HBV)infection rate of breast feeding to newborn babies of HBV carrying parturient women with hepatitis B surface antigen(HBsAg)and hepatitis B e antigen(HBeAg)double positive.Methods A prospective cohort study was conducted to include HBsAg and HBeAg double-positive HBV carrying parturient women and their babies born from February 2016 to May 2018 at the Women′s Hospital,Zhejiang University School of Medicine,and 323 parturient women and 323 babies were enrolled.The babies were divided into breast feeding group and artificial feeding group.Chemiluminescence immunoassay and polymerase chain reaction-fluorescent probe method were used to detect the positive rates of serum HBV markers and HBV DNA levels in the newborns<24 h and seven-month-old age,respectively.The statistical method was performed usingχ^2 test.Results A total of 297 parturient women were finally included for the analysis,including 149 in the breast feeding group and 148 in the artificial feeding group.There were no significant differences in the positive rates of HBsAg,hepatitis B surface antibody(anti-HBs),HBeAg and HBV DNA>100 IU/mL between the two groups at birth<24 h and seven months of age(all P>0.05).The positive rate of anti-HBs in newborns in the breast feeding group at birth<24 h was 58.39%(87/149),which was lower than 95.97%(143/149)at seven months of age.The HBeAg-positive group was 65.10%(97/149)at birth<24 h in the breast feeding group,which was higher than 13.42%(20/149)at seven months of age.The differences were both statistically significant(χ^2=59.75 and 40.49,respectively,both P<0.01).The positive rates of HBsAg and HBV DNA>100 IU/mL in newborns in the breast feeding group were 2.01%(3/149)and 2.68%(4/149)at birth<24 h,respectively,and those at seven months were 2.68%(4/149)and 2.68%(4/149),respectively.There were no significant differences between the two time points(both P>0.05).In the artificial feeding group,the positive rate of anti-HBs in newborns was 47.97%(71/148)at birth<24 h,which was lower than 95.94%(142/148)at seven months of age.The positive rate of HBeAg in the artificial feeding group was 55.41%(82/148)in newborns at birth<24 h,which was higher than 19.59%(29/148)at seven months of age.The differences were statistically significant(χ^2=85.37 and 39.84,respectively,both P<0.01).The positive rates of HBsAg and HBV DNA>100 IU/mL in newborns in the artificial feeding group at birth<24 h were 4.73%(7/148)and 1.35%(2/148),respectively,and those at seven months were 1.35%(2/148)and 1.35%(2/148),respectively.There were no significant differences between the two time points(both P>0.05).Conclusions Breast feeding is not a decisive factor for the risk of vertical transmission in HBsAg and HBeAg double-positive HBV carriers.It is recommended that such women could breastfeed under formal precautions.