目的 探讨HBV高病毒载量孕妇的分娩方式对母婴阻断结果的影响.方法 选择2012年1月1日—2014年12月31日在我院分娩且HBV DNA≥1×106 copies/ml的孕妇570例,分析其分娩方式,检测所生婴儿出生时和完成全程乙型肝炎疫苗免疫后(7~12月龄)的HBV血清学标志物.结果 570例中,289例(50.7%)剖宫产分娩292例活婴(双胎3例),其中新生儿免疫成功270例(92.5%),免疫无应答3例(1.0%),HBV感染19例(6.5%);281例(49.3%)阴道分娩281例活婴,其中新生儿免疫成功252例(89.7%),免疫无应答4例(1.4%),HBV感染25例(8.9%).阴道分娩组所生婴儿母婴阻断失败率稍高于剖宫产组,但差异无统计学意义(8.9%vs 6.5%,χ2=1.153,P=0.283).结论 分娩方式对HBV从母亲血液渗透到婴儿体内无明显影响,对HBV母婴阻断效果无明显影响.%Objective To investigate the effect of delivery modes on blocking mother-to-child transmission of HBV in HBV-infected mothers with high viral load.Methods A total of 570 pregnant women with HBV DNA levels≥1×106 copies/ml, who delivered their babies at our hospital from January 1, 2012 to December 31, 2014, were selected. Their delivery modes were analyzed, and HBV serological markers at neonatal birth and after the whole hepatitis B vaccination (7-12 months old) were detected.Results Totally 292 infants (3 pairs of twins) were born to 289 mothers (50.7%) by caesarean section delivery, of whom 270 newborn infants (92.5%) had immune response to hepatitis B vaccine, 3 (1.0%) didn't have immune response, and 19 (6.5%) were infected with HBV. Totally 281 infants were born to 281 mothers (49.3%) by vaginal delivery, of whom 252 newborn infants (89.7%) had immune response to hepatitis B vaccine, 4 (1.4%) didn't have immune response, and 25 (8.9%) were infected with HBV. The failure rate in blocking mother-to-child transmission in the group of vaginal delivery was higher than that in the group of cesarean section delivery, but the difference between them was not significant (8.9%vs 6.5%,χ2=1.153,P=0.283).Conclusions Methods of delivery have no significant effect on HBV transmission through blood from the mother to the baby, thus having no significant effect on blocking mother-to-child transmission.
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