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目的探讨HBV携带产妇的血清、乳汁中HBV-DNA不同载量与实施母乳喂养安全性的关系及对母婴传播阻断效果的影响。方法应用荧光定量聚合酶链反应和酶免疫测定(EIA)技术对91例HBsAg、HBeAg双阳性产妇血清、乳汁及婴儿24月龄血标本进行HBV-DNA定量和HBVM检测。32例婴儿采用母乳喂养,59例采用人工喂养。对两种喂养方式的婴儿做3(T3)、9(T9)、12(T12)、24(T24)个月追踪检测观察。结果HBsAg、HBeAg双阳性产妇的血清、乳汁中HBV-DNA阳性率为100%、49.45%(P<0.005),HBV-DNA平均含量(拷贝数/毫升的对数,x±s)为(7.43±1.81)、(4.02±1.01);初乳HBV-DNA的检出率随母血HBV-DNA载量的增加而增加,两者呈正相关。母乳和人工两种方式喂养的婴儿HBV感染率为15.63%和13.56%,统计学处理χ2=0.022,P>0.05差异无显著性;母乳喂养组抗体几何平均滴度(GMT)明显高于人工喂养组;发生HBV-DNA感染的13例婴儿T24血标本HBV-DNA载量为(3.24±0.23)。结论HBsAg、HBeAg双阳性产妇血清HBV-DNA载量大于109cps/mL的婴儿是母婴传播的高危易感人群。HBV感染的婴儿HBV-DNA水平较低,病毒载量<104cps/mL。乳汁HBV-DNA阳性率和病毒载量明显低于血清,HBV携带产妇的婴儿接受正规乙肝基因工程疫苗(HBice)全程免疫或HBice和HBIG(乙肝免疫球蛋白)的主、被动联合免疫后,母乳喂养不影响母婴传播阻断效果,母乳喂养有助于提高婴儿抗-HBs的GMT水平。
Objective To investigate the relationship between HBV-DNA load and the safety of breastfeeding in HBV-infected maternal serum and the effect on the blocking effect of mother-to-infant transmission. Methods Serum, milk and infant blood samples of 91 pregnant women with positive HBsAg and HBeAg were detected by quantitative polymerase chain reaction and enzyme immunoassay (EIA). 32 infants were breastfed and 59 were fed artificially. The two feeding methods of infants 3 (T3), 9 (T9), 12 (T12), 24 (T24) months follow-up observation. Results The positive rates of HBV-DNA in serum and milk of HBsAg positive and HBeAg positive women were 100% and 49.45%, respectively (P <0.005). The average HBV DNA content (logarithm of copy number / ml, x ± s) ± 1.81), (4.02 ± 1.01) respectively. The detection rate of HBV-DNA in colostrum increased with the increase of HBV-DNA load in maternal blood. The infection rates of HBV in infants who were breastfed and artificially infants were 15.63% and 13.56%, respectively, and there was no significant difference in statistics (χ2 = 0.022, P> 0.05). The geometric mean titers of GMT in breastfeeding group were significantly higher than those in artificial feeding Group; HBV-DNA load of T24 blood samples of 13 infants with HBV-DNA infection was (3.24 ± 0.23). Conclusion HBsAg and HBeAg-positive maternal serum HBV-DNA load of more than 109cps / mL of infants is a high risk of mother-to-child transmission of susceptible population. HBV-infected infants have lower levels of HBV-DNA with a viral load of <104 cps / mL. The positive rate of HBV-DNA in milk and the viral load were significantly lower than those in serum. The babies born to HBV carriers received full-or combined immunization of HBice and HBIG (hepatitis B immunoglobulin) Breeding does not affect mother-to-child transmission blockade, and breastfeeding helps to increase the GMT level of anti-HBs in infants.