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乙型肝炎(乙肝)病毒(HBV)慢性感染是引起我国人群肝硬化和肝细胞癌的首要危险因素,是我国现阶段面临的重大公共卫生问题之一。由于2002年我国大陆地区普种乙肝疫苗降低了HBV免疫儿童中的横向传播,而对垂直传播的作用有限,故垂直传播已经成为HBV慢性感染的最主要因素。在未进行任何药物治疗的情况下,孕妇外周血乙肝病毒e抗原(HBe Ag)阳性、高病毒载量(≥106拷贝/m L)是发生HBV宫内感染的独立危险因素。宫内HBV感染较儿童期感染和成年HBV人群更易发生慢性HBV感染。为了减少HBV的垂直传播,需要对外周血HBe Ag阳性、高HBV DNA水平的年轻孕妇在孕28周后进行核苷(酸)类似物抗病毒治疗。对于HBe Ag阳性母亲所生的新生儿,除接种乙肝疫苗外,应联合注射乙肝免疫球蛋白(HBIG)治疗。
Chronic hepatitis B virus (HBV) infection is the primary risk factor causing cirrhosis and hepatocellular carcinoma in our country, and is one of the major public health problems facing our country at this stage. Since the universal hepatitis B vaccine in mainland China lowered the horizontal transmission in HBV immune children in 2002 and the effect on vertical transmission was limited, vertical transmission has become the most important factor for chronic HBV infection. In the absence of any medical treatment, pregnant women with positive HBeAg and high viral load (≥106 copies / mL) were independent risk factors for HBV intrauterine infection. Intrauterine HBV infection is more likely to develop chronic HBV infection than childhood infection and adult HBV populations. In order to reduce the vertical transmission of HBV, young pregnant women with HBeAg-positive and high HBV DNA levels in peripheral blood are required to undergo nucleoside (acid) analogue antiviral therapy after 28 weeks’ gestation. For neonates born to HBeAg-positive mothers, hepatitis B immunoglobulin (HBIG) should be given in addition to the hepatitis B vaccine.