乙型肝炎病毒感染孕妇抗病毒治疗对子代体格生长发育的影响

胡芳 卢建军 张书豪 袁晓兰

胡芳, 卢建军, 张书豪, 等. 乙型肝炎病毒感染孕妇抗病毒治疗对子代体格生长发育的影响[J]. 疾病监测, 2022, 37(12): 1542-1546. doi: 10.3784/jbjc.202206210281
引用本文: 胡芳, 卢建军, 张书豪, 等. 乙型肝炎病毒感染孕妇抗病毒治疗对子代体格生长发育的影响[J]. 疾病监测, 2022, 37(12): 1542-1546. doi: 10.3784/jbjc.202206210281
Hu Fang, Lu Jianjun, Zhang Shuhao, et al. Effect of antiviral therapy on physical growth and development of infants born to women infected with hepatitis B virus[J]. Dis Surveill, 2022, 37(12): 1542-1546. doi: 10.3784/jbjc.202206210281
Citation: Hu Fang, Lu Jianjun, Zhang Shuhao, et al. Effect of antiviral therapy on physical growth and development of infants born to women infected with hepatitis B virus[J]. Dis Surveill, 2022, 37(12): 1542-1546. doi: 10.3784/jbjc.202206210281

乙型肝炎病毒感染孕妇抗病毒治疗对子代体格生长发育的影响

doi: 10.3784/jbjc.202206210281
基金项目: 广州市卫生健康委科技一般引导项目(No. 20191A011022);中国疾病预防控制中心妇幼保健中心母婴营养与健康研究项目(No. 2020FYH007);广州市妇女儿童医疗中心/儿科研究所内部科研项目(No. YIP-2019-001)
详细信息
    作者简介:

    胡芳,女,江西省高安市人,硕士,副主任医师,主要从事儿童保健和预防艾滋病、梅毒和乙肝母婴传播工作

    通讯作者:

    胡芳,Tel:020−38857705,Email:hufang0351083@126.com

  • 中图分类号: R211; R512.6

Effect of antiviral therapy on physical growth and development of infants born to women infected with hepatitis B virus

Funds: This study was supported by the fund for Science and Technology General Guidance Project of Guangzhou Municipal Health Commission (No. 20191A011022), National Center for Women and Children's Health, China CDC Maternal and Infant's Nutrition and Health Program (No. 2020FYH007) and the Project of Guangzhou Institute of Pediatrics/Guangzhou Women and Children's Medical Center (No. YIP-2019-001)
More Information
  • 摘要:   目的  了解广东省广州市乙型肝炎病毒(HBV)感染孕妇孕期抗病毒治疗对其子代体格生长发育的影响。  方法  采用前瞻性队列研究,于2018年5月至2021年8月期间,对招募入组的乙肝表面抗原(HBsAg)阳性产妇所生婴儿进行定期追踪随访,孕期进行抗病毒治疗的HBV感染产妇所生儿童为暴露组,孕期未进行抗病毒治疗的HBV感染产妇所生儿童为对照组,采用广义估计方程等方法分析孕期抗病毒治疗对婴儿体重、身长发育的影响。  结果  研究共纳入663名HBV感染产妇所生婴儿,其中115名(17.35%)为暴露组,548名(82.65%)为对照组。 暴露组和对照组婴儿在1、3、6、12月龄时低体重、生长迟缓、消瘦的发生率差异无统计学意义(P>0.05),年龄别体重Z分、年龄别身长Z分和身长别体重Z分差异亦无统计学意义,且与世界卫生组织的参考标准差异无统计学意义。 暴露组婴儿年龄别身长Z分是对照组婴儿的0.585倍(P=0.021)。  结论   HBV感染孕妇孕期抗病毒治疗对其子代婴儿期体重和身长发育无影响。
  • 图  1  暴露组和对照组婴儿体格发育指标Z分的变化情况

    Figure  1.  Changes in Z scores of physical growth of infants in exposure group and control group

    表  1  暴露组和对照组婴儿母亲基本特征和分娩情况比较

    Table  1.   Comparison of basic and delivery information of mothers infected with HBV between exposure group and control group

    变量暴露组
    n=115)
    对照组
    n=548)
    P
    母亲分娩时年龄
    (岁,$\bar{x} \pm s$)
    29.97±4.48 31.16±4.99 0.019
    母亲民族 0.347
     汉族 114 (99.13) 532 (97.08)
     其他 1 (0.87) 16 (2.92)
    母亲文化程度 0.057
     初中及以下 26 (22.61) 152 (27.74)
     高中(含职高) 26 (22.61) 141 (25.73)
     大专 19 (16.52) 114 (20.80)
     本科及以上 44 (38.26) 141 (25.73)
    母亲职业 0.006
     待业 11 (9.57) 112 (20.44)
     从业 104 (90.43) 436 (79.56)
    母亲户籍 0.001
     广州 99 (86.09) 385 (70.26)
     非广州 16 (13.91) 163 (29.74)
    产次 0.048
     初产妇 66 (57.39) 259 (47.26)
     经产妇 49 (42.61) 289 (52.74)
    母亲HBeAg <0.01
     阴性 22 (19.13) 413 (75.36)
     阳性 93 (80.87) 135 (24.64)
    婴儿性别 0.760
     男性 66 (57.39) 306 (55.84)
     女性 49 (42.61) 242 (44.16)
    分娩方式 0.163
     顺产 57 (49.57) 310 (56.57)
     助产 8 (6.96) 20 (3.65)
     剖宫产 50 (43.48) 218 (39.78)
    出生胎龄
    (d,$\bar{x} \pm s$)
    269.90±11.40 270.00±11.50 0.931
     足月产 103 (89.57) 509 (92.88) 0.225
     早产 12 (10.43) 39 (7.12)
    出生体重
    (g,$\bar{x} \pm s$)
    3183.39±424.05 3183.69±460.33 0.995
     低 4 (3.48) 31 (5.66) 0.342
     正常 111 (96.52) 517 (94.34)
    6月龄以内喂养方式 0.094
     纯母乳喂养 21 (18.26) 134 (24.45)
     混合喂养 54 (46.96) 274 (50.00)
     人工喂养 40 (34.78) 140 (25.55)
    注:括号内数据为百分比,括号外数据例数
    下载: 导出CSV

    表  2  暴露组和对照组婴儿在各时点的低体重、生长迟缓和消瘦发生情况

    Table  2.   Incidences of underweight, stunting and wasting at different time points in exposure group and control group

    项目1月龄
    n=587)
    3月龄
    n=263)
    6月龄
    n=564)
    12月龄
    n=446)
    低体重9 (1.53)7 (2.66)7 (1.24)5 (1.12)
     暴露组1 (0.98)0 (0.00)0 (0.00)0 (0.00)
     对照组8 (1.65)7 (3.30)7 (1.51)5 (1.36)
     P0.9550.4060.4550.650
    生长迟缓26 (4.43)11 (4.18)22 (3.90)16 (3.59)
     暴露组2 (1.96)0 (0.00)4 (3.96)3 (3.80)
     对照组24 (4.95)11 (5.19)18 (3.89)13 (3.54)
     P0.2850.2031.0001.000
    消瘦5 (0.85)2 (0.76)4 (0.71)4 (0.90)
     暴露组3 (2.94)0 (0.00)0 (0.00)0 (0.00)
     对照组2 (0.41)2 (0.94)4 (0.86)4 (1.09)
     P0.0531.0000.7770.784
    注:括号内数据为百分比(%),括号外数据为例数(例)
    下载: 导出CSV

    表  3  广义估计方程分析婴儿体格生长发育指标Z分的影响因素

    Table  3.   Influencing factors of Z scores of infants’ physical growth by Generalized Estimation Equation

    因变量OR值(95%CIWald χ2P
    年龄别身长Z
     孕期抗病毒治疗(暴露组)0.585
    (0.371~0.923)
    5.3120.021
    年龄别体重Z
     孕期抗病毒治疗(暴露组)0.906
    (0.528~ 1.553)
    0.1290.719
    身长别体重Z分
     孕期抗病毒治疗(暴露组)1.352
    (0.775~ 2.357)
    1.1290.288
    注:调整变量有母亲年龄(连续性变量)、职业、户籍、孕产史、HBeAg感染状态、出生胎龄(连续性变量)
    下载: 导出CSV
  • [1] World Health Organization Regional Office for Western Pacific. Regional framework for the triple elimination of mother-to-child transmission of HIV, hepatitis B and syphilis in Asia and the Pacific, 2018−2030[EB/OL]. (2018-08-09)[2020-09-29]. https://www.who.int/publications/i/item/9789290618553.
    [2] 广东省卫计委办公室. 关于开展“乙肝母婴零传播”综合干预试点工作的通知[EB/OL]. (2018-08-22) [2020-09-29]. https://static.nfapp.southcn.com/content/201808/22/c1421335.html.

    Guangdong Provincial Health and Family Planning Commission. Notice on launching the comprehensive intervention pilot work of “zero transmission of hepatitis B from mother to child”[EB/OL]. (2018-08-22) [2020-09-29]. https://static.nfapp.southcn.com/content/201808/22/c1421335.html.
    [3] Society for Maternal-Fetal Medicine (SMFM), Dionne-Odom J, Tita ATN, et al. #38: hepatitis B in pregnancy screening, treatment, and prevention of vertical transmission[J]. Am J Obstet Gynecol, 2016, 214(1): 6–14. DOI:  10.1016/j.ajog.2015.09.100.
    [4] 中国肝炎防治基金会, 中华医学会感染病学分会, 中华医学会肝病学分会. 乙型肝炎母婴阻断临床管理流程[J]. 中华肝脏病杂志,2017,25(4):254–256. DOI:10.3760/cma.j.issn.1007−3418.2017.04.004.

    Chinese Foundation for Hepatitis Prevention and Control, Chinese Society of Infectious Diseases Chinese Medical Association, Chinese Society of Hepatology Chinese Medical Association. Management algorithm for interrupting mother-to-child transmission of hepatitis B[J]. Chin J Hepatol, 2017, 25(4): 254–256. DOI: 10.3760/cma.j.issn.1007−3418.2017.04.004.
    [5] 中华医学会妇产科学分会产科学组, 中华医学会围产医学分会. 乙型肝炎病毒母婴传播预防临床指南(2020)[J]. 中华围产医学杂志,2020,23(5):289–298. DOI:10.3760/cma.j.cn113903−20200512−00445.

    Obstetrics Group, Obstetrics and Gynecology Branch, Chinese Medical Association, Perinatal Medicine Branch of Chinese Medical Association. Clinical guideline on prevention of mother-to-child transmission of hepatitis B virus (2020)[J]. Chin J Perinat Med, 2020, 23(5): 289–298. DOI: 10.3760/cma.j.cn113903−20200512−00445.
    [6] 国家卫生健康委办公厅. 关于预防艾滋病、梅毒和乙肝母婴传播工作规范(2020年版)的通知[EB/OL]. (2020-11-25)[2022-05-20]. http://www.nhc.gov.cn/fys/s3581/202011/fc7b46b2b48b45a69bd390ae3a62d065.shtml.

    General Office of National Health Commission. Notice on the issuance of the specification for the prevention of mother to child transmission of HIV/AIDS, syphilis and hepatitis B (2020 edition) [EB/OL]. (2020-11-25)[2022-05-20]. http://www.nhc.gov.cn/fys/s3581/202011/fc7b46b2b48b45a69bd390ae3a62d065.shtml.
    [7] 周乙华, 胡娅莉. 妊娠晚期抗病毒治疗预防乙型肝炎病毒母婴传播: 利还是弊?[J]. 中华妇产科杂志,2017,52(2):82–85. DOI:10.3760/cma.j.issn.0529−567x.2017.02.003.

    Zhou YH, Hu YL. Antiviral therapy for prevention of mother-to-child transmission of hepatitis B virus in third trimester: benefit or harm?[J]. Chin J Obstet Gynecol, 2017, 52(2): 82–85. DOI: 10.3760/cma.j.issn.0529−567x.2017.02.003.
    [8] Wen WH, Chen HL, Shih TTF, et al. Long-term growth and bone development in children of HBV-infected mothers with and without fetal exposure to tenofovir disoproxil fumarate[J]. J Hepatol, 2020, 72(6): 1082–1087. DOI:  10.1016/j.jhep.2020.01.021.
    [9] Fenton TR, Nasser R, Eliasziw M, et al. Validating the weight gain of preterm infants between the reference growth curve of the fetus and the term infant[J]. BMC Pediatr, 2013, 13: 92. DOI: 10.1186/1471−2431−13−92.
    [10] World Health Organization. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development[R/OL]. (2006-11-11) [2020-09-29]. https://www.who.int/publications/i/item/924154693X.
    [11] 《中华儿科杂志》编辑委员会, 中华医学会儿科学分会儿童保健学组. 中国儿童体格生长评价建议[J]. 中华儿科杂志,2015,53(12):887–892. DOI:10.3760/cma.j.issn.0578−1310.2015.12.003.

    “Chinese Journal of Pediatrics” Editorial Board, and Child Health Care Subgroup, Pediatrics, Chinese Medical Association. Evaluation suggestions of physical growth of Chinese children[J]. Chin J Pediatr, 2015, 53(12): 887–892. DOI: 10.3760/cma.j.issn.0578−1310.2015.12.003.
    [12] Funk AL, Lu Y, Yoshida K, et al. Efficacy and safety of antiviral prophylaxis during pregnancy to prevent mother-to-child transmission of hepatitis B virus: a systematic review and meta-analysis[J]. Lancet Infect Dis, 2021, 21(1): 70–84. DOI: 10.1016/S1473−3099(20)30586−7.
    [13] Cornberg M, Lok ASF, Terrault NA, et al. Guidance for design and endpoints of clinical trials in chronic hepatitis B-report from the 2019 EASL-AASLD HBV treatment endpoints conference[J]. J Hepatol, 2020, 72(3): 539–557. DOI:  10.1016/j.jhep.2019.11.003.
    [14] World Health Organization. Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection[EB/OL]. (2015-03-01)[2020-09-29].https://www.who.int/publications/i/item/9789241549059.
    [15] Shamshirsaz AA, Sellner AA, Erfani H, et al. An ethical framework for research in maternal-fetal intervention in the presence of maternal human immunodeficiency virus or hepatitis B and C infection[J]. Obstet Gynecol, 2019, 133(1): 48–52. DOI:  10.1097/AOG.0000000000003022.
    [16] Chang KC, Chang MH, Lee CN, et al. Decreased neonatal hepatitis B virus (HBV) viremia by maternal tenofovir treatment predicts reduced chronic HBV infection in children born to highly viremic mothers[J]. Aliment Pharmacol Ther, 2019, 50(3): 306–316. DOI:  10.1111/apt.15321.
    [17] Jourdain G, Ngo-Giang-Huong N, Harrison L, et al. Tenofovir versus placebo to prevent perinatal transmission of hepatitis B[J]. N Engl J Med, 2018, 378(10): 911–923. DOI:  10.1056/NEJMoa1708131.
    [18] Wang M, Bian Q, Zhu YX, et al. Real-world study of tenofovir disoproxil fumarate to prevent hepatitis B transmission in mothers with high viral load[J]. Aliment Pharmacol Ther, 2019, 49(2): 211–217. DOI:  10.1111/apt.15064.
    [19] 石跃, 朱丽影, 于雷, 等. 乙型肝炎病毒携带者妊娠期及哺乳期应用替诺福韦的研究进展[J]. 中华传染病杂志,2018,36(5):314–316. DOI:10.3760/cma.j.issn.1000−6680.2018.05.015.

    Shi Y, Zhu LY, Yu L, et al. Research on the application of tenofovir during pregnancy and lactation in women with HBV infection[J]. Chin J Infect Dis, 2018, 36(5): 314–316. DOI: 10.3760/cma.j.issn.1000−6680.2018.05.015.
  • 加载中
图(1) / 表(3)
计量
  • 文章访问数:  157
  • HTML全文浏览量:  88
  • PDF下载量:  16
  • 被引次数: 0
出版历程
  • 收稿日期:  2022-06-21
  • 网络出版日期:  2022-11-24
  • 刊出日期:  2022-12-01

目录

    /

    返回文章
    返回

    在线交流

    防诈骗公告

    大家好:近期有不法分子以本刊编辑身份添加作者微信,请务必提高警惕!本刊关于稿件的一切事项通知均采用编辑部唯一邮箱(jbjc@icdc.cn)和座机(010-58900732)联系作者,且在录用稿件后仅收取版面费,无其他任何名目费用(如审稿费和加急费等),非编辑部邮箱发送的本刊收费用通知等均为诈骗,不要随意汇入款项!如有可疑及时致电编辑部核实确认!