本文關(guān)鍵詞： 乙肝感染 孕婦 新生兒 母嬰傳播　出處：《鄭州大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：研究背景乙型病毒性肝炎(Hepatitis B,HB)是全球主要的公共衛(wèi)生問(wèn)題之一。全球范圍內(nèi)約有20億人感染過(guò)HBV,其中約有3.5億人成為慢性感染者。母嬰傳播是HBV感染的主要原因。30%~50%的HBV攜帶者是由于HBV母嬰傳播導(dǎo)致的宮內(nèi)感染或幼兒期感染。如果孕婦HBsAg和HBeAg都為陽(yáng)性,母嬰傳播率可高達(dá)90%,感染時(shí)年齡越小,變成慢性攜帶者的概率越高。因此,阻斷母嬰傳播對(duì)控制我國(guó)乙肝流行及預(yù)防HBV相關(guān)肝病具有重要的意義。目前,對(duì)孕產(chǎn)婦進(jìn)行乙肝感染狀況篩查,對(duì)新生兒接種乙肝疫苗,同時(shí)對(duì)乙肝表面抗原陽(yáng)性母親的新生兒接種免疫球蛋白是預(yù)防和控制乙肝母嬰傳播的主要措施。深圳市自2002年開(kāi)始向所有新生兒免費(fèi)提供三針乙肝疫苗注射,2010年開(kāi)始每年對(duì)全市接近20萬(wàn)孕婦進(jìn)行HBsAg篩查,并對(duì)陽(yáng)性孕婦的新生兒給予HBIG和乙肝疫苗聯(lián)合免疫阻斷措施。對(duì)深圳市實(shí)施預(yù)防和控制乙肝母嬰阻斷措施之后孕婦的乙肝感染狀況和乙肝母嬰阻斷措施的效果尚未進(jìn)行評(píng)價(jià)。研究目的通過(guò)對(duì)深圳市孕婦開(kāi)展乙肝感染免費(fèi)檢測(cè),了解深圳市孕婦乙肝感染狀況;比較流動(dòng)人口和戶籍人口孕婦乙肝感染狀況;對(duì)新生兒乙肝母嬰阻斷措施的實(shí)施效果進(jìn)行評(píng)價(jià),為進(jìn)一步改進(jìn)和完善深圳市預(yù)防和控制乙肝母嬰傳播項(xiàng)目提供參考依據(jù)。對(duì)象與方法對(duì)象:2011年1月1日至2015年12月31日期間深圳市所有到助產(chǎn)機(jī)構(gòu)進(jìn)行孕期檢查的孕婦,以及2015年所有乙肝表面抗原陽(yáng)性孕婦所生新生兒。方法:對(duì)深圳市所有到助產(chǎn)機(jī)構(gòu)進(jìn)行孕期檢查的孕婦在知情同意的前提下,進(jìn)行乙肝兩對(duì)半檢測(cè),檢測(cè)結(jié)果由首診醫(yī)生錄入“深圳市婦幼保健管理系統(tǒng)”中的乙肝專(zhuān)項(xiàng)模塊;社區(qū)健康服務(wù)中心預(yù)防接種醫(yī)生督促陽(yáng)性孕婦在兒童完成三針乙肝疫苗接種后,讓其帶兒童到上級(jí)醫(yī)院進(jìn)行乙肝兩對(duì)半檢測(cè),并將檢測(cè)結(jié)果錄入上述系統(tǒng),于2015年抽取一定數(shù)量陽(yáng)性孕婦所生兒童進(jìn)行干預(yù)效果評(píng)價(jià)。從系統(tǒng)中將2011~2015年深圳市全市孕婦基本信息及乙肝血清學(xué)檢測(cè)結(jié)果、HBsAg陽(yáng)性孕婦的新生兒相關(guān)信息導(dǎo)出,利用Excel2010和SPSS21.0軟件進(jìn)分析。用χ2和Fisher確切概率法檢驗(yàn)變量間的差異性,運(yùn)用二元logistic回歸分析戶籍、年齡等因素對(duì)HBsAg、抗-HBs的影響。所有統(tǒng)計(jì)學(xué)檢驗(yàn)均為雙側(cè)檢驗(yàn),P0.05為差異具有統(tǒng)計(jì)學(xué)意義。研究結(jié)果深圳市2011~2015年間實(shí)際共檢測(cè)乙肝五項(xiàng)孕婦為732783例。其中流動(dòng)人口孕婦635554例(86.73%),戶籍人口孕婦有97229例(13.27%)。深圳市孕婦HBs Ag陽(yáng)性率、抗-HBs陽(yáng)性率、HBeAg陽(yáng)性率、抗-HBe陽(yáng)性率和抗-HBc陽(yáng)性率分別為8.66%、49.27%、3.10%、12.97%、22.27%;HBsAg陽(yáng)性孕婦的HBeAg陽(yáng)性率、抗-HBe陽(yáng)性率分別為30.25%、53.51%;流動(dòng)人口孕婦HBsAg陽(yáng)性率(8.83%)高于戶籍人口孕婦(7.62%),抗-HBs陽(yáng)性率(46.03%)低于戶籍人口孕婦(70.41%)。流動(dòng)人口和孕次較多是乙肝感染的危險(xiǎn)因素,文化程度高是其保護(hù)因素。2015年HBsAg陽(yáng)性孕婦所生新生兒完成乙肝兩對(duì)半檢測(cè)者共6376例,乙肝疫苗首針及時(shí)接種率為97.09%,HBsAg、抗-HBs陽(yáng)性率分別為0.87%、95.65%.研究結(jié)論1.深圳市孕婦HBsAg陽(yáng)性率(8.66%)及HBsAg與HBeAg雙陽(yáng)性孕婦占比仍較高,實(shí)施乙肝母嬰阻斷,具有重要的公共衛(wèi)生意義。2.外來(lái)流動(dòng)人口孕婦HBsAg陽(yáng)性率高于深圳市戶籍人口孕婦,應(yīng)重視乙肝母嬰阻斷項(xiàng)目的公共衛(wèi)生均等化。3.深圳市乙肝母嬰阻斷首針乙肝疫苗和HBIG接種率均較高,干預(yù)效果較好,且效果優(yōu)于全國(guó)。
[Abstract]:The research background of hepatitis B virus (Hepatitis B HB) is one of the main public health problem in the world. There are about 2 billion people infected with HBV worldwide, of which about 350 million people become chronically infected..30%~50% maternal transmission is the main reason for HBV infection of HBV carriers is infected by mother to child transmission of HBV intrauterine lead to infection or early childhood. If HBsAg and HBeAg are positive for pregnant women, maternal transmission rate can be as high as 90%. The infection age is smaller, the higher the probability to become chronic carriers. Therefore, blocking mother to child transmission plays an important role in the control of China's hepatitis B epidemic and prevention of HBV related liver disease. At present, the maternal HBV infection the status of newborn screening, hepatitis B vaccine, and neonatal vaccination immunoglobulin on hepatitis B surface antigen positive mothers are the main measures of prevention and control of mother to child transmission of hepatitis B in Shenzhen city since 2002. To provide free of charge to all three neonatal hepatitis B vaccine injection needle, the beginning of the year in 2010 HBsAg screening for the nearly 200 thousand pregnant women, and the pregnant women with positive neonates treated with immune HBIG and hepatitis B vaccine in blocking measures. The implementation of the prevention and control of hepatitis B in pregnant women with maternal and infant blocking measures after hepatitis B infection and hepatitis B PMTCT measures not evaluation of Shenzhen city. The purpose of the study through the free detection of hepatitis B infection on pregnant women in Shenzhen city to carry out, understand the HBV infection status of pregnant women in Shenzhen city; comparison of floating population and household population of pregnant women with hepatitis B infection; the treatment effect on neonatal hepatitis B vertical evaluation block, for further improving and perfecting the city of Shenzhen to provide reference for the prevention and control of hepatitis B mother to child transmission project. Objects and methods: during the period from January 1, 2011 to December 31, 2015 in Shenzhen City All the midwifery institutions pregnancy checks for pregnant women, and the 2015 all HBsAg positive newborns. Methods: all Shenzhen city to midwifery institutions during pregnancy examination of pregnant women informed consent under the premise of two semi hepatitis B testing, hepatitis B special module detection result by the first doctor into the Shenzhen City Maternal and child health management system in the community health service center; vaccination doctors urge positive pregnant women completed three doses of hepatitis B vaccine in children, let the children take to the hospital for a higher level of two semi hepatitis B testing, and test results of the system input, in 2015 for a certain number of positive pregnant women born children from intervention. The detection results of pregnant women in Shenzhen city and the basic information of hepatitis B serological system, 2011~2015, information derived from neonatal HBsAg positive pregnant women, Using Excel2010 and SPSS21.0 software analysis. The difference between 2 and Fisher exact probability test between the variables in X, with two yuan logistic regression analysis of residence, age and other factors on the HBsAg effects of anti -HBs. All statistical tests were two-sided test, P0.05 the difference has statistical significance. The research results of Shenzhen city during 2011~2015 the actual total of five pregnant women for the detection of hepatitis B in 732783 cases. 635554 cases of floating population of pregnant women (86.73%), household population of pregnant women has 97229 cases (13.27%). The positive rate of Ag in pregnant women in Shenzhen City, HBs, anti -HBs positive rate, HBeAg positive rate, the positive rate of anti -HBe and anti -HBc positive rate were 8.66%, 49.27%, 3.10%, 12.97%, 22.27%; the positive rate of HBeAg HBsAg positive pregnant women, the positive rate of anti -HBe were 30.25%, 53.51%; the positive rate of HBsAg in pregnant women of floating population (8.83%) is higher than that of the household population of pregnant women (7.62%), anti -HBs positive rate (46.03%) lower than the household population. Women (70.41%). The floating population and more times of pregnancy is a risk factor for hepatitis B infection, high educational level is a protective factor for.2015 in HBsAg positive newborns completed two semi hepatitis B testing 6376 cases, timely first dose of hepatitis B vaccine inoculation rate was 97.09%, HBsAg, anti -HBs positive rate was 0.87%. Conclusion 95.65%. 1. pregnant women in Shenzhen City, the positive rate of HBsAg (8.66%) and HBsAg and HBeAg positive pregnant women the proportion is still high, the implementation of the hepatitis B PMTCT, with the positive rate of public health significance of migrant pregnant women.2. HBsAg important than Shenzhen household population of pregnant women, should pay attention to hepatitis B PMTCT project of public health equalization in Shenzhen.3. hepatitis B PMTCT first dose of hepatitis B vaccine and vaccination rate of HBIG was higher and the intervention effect is good, and the effect is better than that of the country.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R714.251

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