丙型肝炎病毒的母婴传播：可预防的围产期传播证据。

Mother-to-child transmission of hepatitis C virus: evidence for preventable peripartum transmission.

作者信息

Gibb D M, Goodall R L, Dunn D T, Healy M, Neave P, Cafferkey M, Butler K

机构信息

Medical Research Council Clinical Trials Unit, London, UK.

出版信息

Lancet. 2000 Sep 9;356(9233):904-7. doi: 10.1016/s0140-6736(00)02681-7.

DOI:10.1016/s0140-6736(00)02681-7

PMID:11036896

Abstract

BACKGROUND

Little information is available about the timing of mother-to-child transmission of hepatitis C virus (HCV), and no interventions to decrease transmission rates have been identified. We examined the effect of risk factors, including mode of delivery, on the vertical transmission rate.

METHODS

Data from HCV-infected women and their infants from three hospitals in Ireland and from a British Paediatric Surveillance Unit study of infants born to HCV-infected mothers were used to estimate the vertical transmission rate and risk factors for transmission. We used a probabilistic model using methods that simultaneously estimated the time to HCV-antibody loss in uninfected infants and the diagnostic accuracy of PCR tests for HCV RNA.

FINDINGS

441 mother-child pairs from the UK (227) and Ireland (214) were included. 50% of uninfected children became HCV-antibody negative by 8 months and 95% by 13 months. The estimated specificity of PCR for HCV RNA was 97% (95% CI 96-99) and was unrelated to age; sensitivity was only 22% (7-46) in the first month but rose sharply to 97% (85-100) thereafter. The vertical transmission rate was 6.7% (4.1-10.2) overall, and 3.8 times higher in HIV coinfected (n=22) than in HIV-negative women after adjustment for other factors (p=0.06). No effect of breastfeeding on transmission was observed, although only 59 women breastfed. However, delivery by elective caesarean section before membrane rupture was associated with a lower transmission risk than vaginal or emergency caesarean-section delivery (odds ratio 0 [0-0.87], p=0.04, after adjustment for other factors).

INTERPRETATION

The low sensitivity of HCV RNA soon after birth and the finding of a lower transmission rate after delivery by elective caesarean section suggest that HCV transmission occurs predominantly around the time of delivery. If the findings on elective caesarean section are confirmed in other studies, the case for antenatal HCV testing should be reconsidered.

摘要

背景

关于丙型肝炎病毒（HCV）母婴传播的时间信息很少，且尚未确定降低传播率的干预措施。我们研究了包括分娩方式在内的危险因素对垂直传播率的影响。

方法

来自爱尔兰三家医院的HCV感染女性及其婴儿的数据，以及英国儿科监测单位对HCV感染母亲所生婴儿的一项研究数据，用于估计垂直传播率和传播的危险因素。我们使用了一种概率模型，采用的方法同时估计未感染婴儿HCV抗体消失的时间以及HCV RNA PCR检测的诊断准确性。

研究结果

纳入了来自英国（227对）和爱尔兰（214对）的441对母婴。50%的未感染儿童在8个月时HCV抗体转阴，95%在13个月时转阴。HCV RNA PCR检测的估计特异性为97%（95%CI 96 - 99），且与年龄无关；第一个月的敏感性仅为22%（7 - 46），但此后急剧上升至97%（85 - 100）。总体垂直传播率为6.7%（4.1 - 10.2），在调整其他因素后，合并感染HIV的女性（n = 22）的传播率比未感染HIV的女性高3.8倍（p = 0.06）。未观察到母乳喂养对传播有影响，尽管只有59名女性进行母乳喂养。然而，与阴道分娩或急诊剖宫产相比，胎膜破裂前择期剖宫产的传播风险较低（调整其他因素后比值比为0 [0 - 0.87]，p = 0.04）。