【作者】 刘竹青；

【导师】 王正平；

【作者基本信息】 浙江大学 ， 临床医学， 2009， 硕士

【摘要】 背景:乙型肝炎病毒是一种严重危害人类健康的世界性传染病。据专家估计,全球约有20亿人感染乙型肝炎病毒(HBV),乙肝病毒表面抗原(HBsAg)携带者3.5亿人,每年有75万人死于HBV感染引起的疾病。乙肝高发区的感染多发生在婴幼儿期,30%感染乙肝病毒的孕妇在围产期可将病毒传给婴儿。我国HBV携带者中50%以上为母婴传播所致。婴儿时期感染HBV,容易形成慢性带毒状态,是肝硬化和肝癌的高危因素。因此阻断HBV母婴传播是控制乙肝流行及预防HBV相关性肝病的关键。而关于HBV携带产妇能否行母乳喂养尚无定论。一方面母乳喂养增加婴儿与有传染性母亲的接触机会,而另一方面人工喂养不仅增加家庭和社会的负担,还容易引起营养不良等影响婴儿的生长发育,因此携带HBV母亲的婴儿母乳喂养是否安全是个急需回答的问题。反对母乳喂养者认为HBV携带产妇的乳汁尤其是初乳中可检出HBV感染性标志物如HBV-DNA、HBsAg等,提示母乳有传播病毒的可能。故反对HBV携带者尤其是HBsAg,HBeAg双阳产妇进行母乳喂养。亦有学者通过研究认为乙肝病毒携带产妇不同喂养方式对婴儿感染HBV没有影响。目前为止母乳喂养是否增加婴儿HBV感染风险仍有争议。因此我们收集了10篇关于主被动联合免疫后HBV携带产妇的婴儿不同喂养方式与HBV感染关系的研究,用于探讨联合免疫后母乳喂养的安全性问题。目的:本研究主要是通过分析HBV携带产妇的婴儿联合免疫后母乳喂养与人工喂养HBV感染率是否存在显著性差异,探讨联合免疫后HBV携带者母乳喂养的安全性问题。方法:应用关键词:“乙型肝炎病毒”、“联合免疫”、“母乳喂养”、“母婴传播”检索Medline医学数据库、SDOS全文数据库、中国生物医学光盘数据库、中国学术期刊全文数据库,以及文献追溯等途径收集国内外2002—2007年间公开发表的关于主被动联合免疫后HBV携带产妇的婴儿不同喂养方式与HBV感染关系的报道。按纳人标准及排除标准从中选择符合标准的对象共10篇,其中9篇中文文献,1篇英文文献,作Meta分析。对各研究结果进行异质性检验并计算合并OR值及95%可信区间,用Review Manager 4.2分析软件进行统计分析,综合评价分析HBV携带产妇喂养方式对婴儿感染HBV的影响。结果:总共2002-2007年之间10个研究文献入选,病例数共计1575例。母乳喂养707人,其中婴儿感染HBV 31例;人工喂养868人,其中婴儿感染HBV 42例。综合结果表明:Z=1.53,P=0.13＞0.05,合并OR=0.67,OR 95%CI[0.41,1.12],表明主被动联合免疫后HBV携带产妇的婴儿母乳喂养组感染HBV与人工喂养组相比无显著性差异。结论:HBV携带产妇的婴儿经过乙肝疫苗及乙肝免疫球蛋白联合免疫后可以进行母乳喂养。主被动联合免疫后HBV携带产妇的婴儿母乳喂养组感染HBV与人工喂养组相比无显著性差异。HBV携带产妇不同喂养方式与婴儿感染HBV无明显相关性。更多还原

【Abstract】 Background:Hepatitis B virus(HBV) infection is a worldwide health problem.It is one of the most common and important human viral infections.The infection can cause acute and chronic liver diseases,ranging from fulminant hepatitis to cirrhosis and eventually hepatocellular carcinoma(HCC).Worldwide,as many as 350 million people are chronically infected with HBV,and 1 million deaths are attributed to its infection. HBV can be transmitted either perinatally or horizontally to the child.Perinatal transmission from highly infectious mothers to their neonates is an important route for HBV infection.It accounts for about 40-50%.Infection with HBV in infancy or early childhood may lead to a high rate of persistent infection(25-90%).Hence,the control of HBV infection is extremely important.Transmission of HBV through breast feeding has been reported in several studies.Several groups have recommended against breast-feeding on the basis of those data.The proscription of breast-feeding appears justified,if it is associated with any increased risk,of HBV transmission and its long-term consequences.However,the mechanism and risks of transmission of hepatitis B in breast milk are not well understood.In order to explore the safety of HBV transmission in breast-feeding infants of HBV carriers after combination immunoprophylaxis,we collected related literatures by systematic literature search,and compared the risk of HBV transmission from HBV carriers to infants who were and were not breast-fed.Objective:To explore the risk of HBV transmission in breast-feeding infants of HBV carriers after combination immunoprophylaxis. Methods:Relevant literatures were collected by systematic literature search. Meta-analysis was applied to the selected literatures that met the criteria.The heterogeneity across the studies was checked.The pooled OR and 95%confidence interval were calculated.The meta-analysis software,review manager 4.2,was applied for statistical analysis.The influence of HBV carrier mothers’ different feeding modes on the infection of hepatitis B in infants was overall evaluated.Results:A total of 1575 cases from 10 studies which met the criteria were included. The breast-feeding cases were 707,from which 31 HBV infection cases;while 868 artificial feeding,from which 42 HBV infection cases.There was no statistically difference between the two feeding methods of HBV carrier mothers after combined immunoprophylaxis with respect to the HBV-infectious rate of newborns(z=1.53, P=0.13＞0.05).The pooled OR value was 0.67,with 95%confidence interval ranging from 0.41 to 1.12.Conclusion:With the combined immunoprophylaxis,breast-feeding infants of HBV carriers poses no additional risk for the transmission of HBV.更多还原