Barros Monica Maia de Oliveira, Ronchini Karla Regina Oliveira de Moura, Soares Rosa Leonôra Salerno
Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Serviço de Ambulatório, Rio de Janeiro, RJ, Brasil.
Universidade Federal Fluminense, Faculdade de Medicina, Departamento de Medicina Interna, Rio de Janeiro, RJ, Brasil.
Arq Gastroenterol. 2018 Jul-Sep;55(3):267-273. doi: 10.1590/S0004-2803.201800000-68.
Hepatitis B and C are diseases with high morbimortality and constitute a global public health problem. In Brazil, the prevalence is not homogeneous, oscillating among different regions, but it is estimated that currently about 1% of the population present chronic disease related to the B virus and that there are 1.5 million infected with the C virus. Despite the development of hepatitis B vaccine, improvement in diagnostic methods and therapeutic advances in the field of viral hepatitis, there is still a large number of people who continues to be infected by these viruses, especially in populations at risk and also due to several factors, including vaccination and migration policies. Vertical and perinatal transmissions are of great importance in the epidemiology of viral hepatitis and the blood tests performed during prenatal care constitute a great opportunity for screening and identifying these viruses.
To evaluate the seroprevalence of markers for B and C viruses in women who underwent prenatal care at the Hospital Universitário Antônio Pedro (Antonio Pedro University Hospital) from 2006 to 2013 and to compare the results found with regional data and those described in the specific literature.
A descriptive, cross-sectional, quantitative study with retrospective data collected from 635 records of pregnant women attended at the Prenatal Service of the Hospital Universitário Antônio Pedro, Niterói, state of Rio de Janeiro, from March 2006 until December 2013. The database was built in the Microsoft Office Access program and was later exported to Microsoft Office Excel. For the processing and analysis of the data, it was used the SPSS (Statistical Package for Social Science, IBM) version 22.0, for Windows.
Twelve cases with positive HBsAg (1.9%), 189 cases with positive anti-HBs (35.9%) and seven positive anti-HCV patients (1.3%) were observed. There was no significant association between age and positivity for HBsAg, anti-HBs and anti-HCV (P =0.205, 0.872 and 0.676, respectively). There was a direct relationship between the anti-HBs positivity and the last four years of the study (P<0.0001).
A high prevalence of HBsAg was observed, higher than the expected for the evaluated region; there was a prevalence of anti-HCV, consistent with the current Brazilian reality; and a likely low rate of hepatitis B immunization, with a relatively high rate of susceptibility to this infection and no case of co-infection between B and C viruses and HIV. It is emphasized not only the need to trace hepatitis B and C, without exceptions, during prenatal care, since even though the current advances in therapy may not cure, at least they may allow a better quality of life for patients with chronic disease and the mandatory completion of immunoprophylaxis in all newborns. Special attention should be given to those patients susceptible to HBV, with prompt diagnosis and referral for specific vaccination.
乙型和丙型肝炎是高发病率和高死亡率的疾病,构成全球公共卫生问题。在巴西,患病率并不均匀,在不同地区有所波动,但据估计,目前约1%的人口患有与B病毒相关的慢性病,有150万人感染了C病毒。尽管乙型肝炎疫苗有所发展,诊断方法有所改进,病毒性肝炎领域的治疗也取得了进展,但仍有大量人群继续感染这些病毒,特别是在高危人群中,而且由于包括疫苗接种和移民政策在内的多种因素。垂直传播和围产期传播在病毒性肝炎的流行病学中非常重要,产前检查期间进行的血液检测为筛查和识别这些病毒提供了绝佳机会。
评估2006年至2013年在安东尼奥·佩德罗大学医院(Hospital Universitário Antônio Pedro)接受产前检查的女性中B和C病毒标志物的血清流行率,并将所得结果与区域数据及特定文献中描述的数据进行比较。
一项描述性、横断面、定量研究,采用回顾性数据,收集了2006年3月至2013年12月在里约热内卢州尼泰罗伊市安东尼奥·佩德罗大学医院产前服务部就诊的635名孕妇的记录。数据库在Microsoft Office Access程序中建立,随后导出到Microsoft Office Excel。数据处理和分析使用适用于Windows的SPSS(社会科学统计软件包,IBM)22.0版。
观察到12例HBsAg阳性(1.9%),189例抗-HBs阳性(35.9%),7例抗-HCV阳性患者(1.3%)。年龄与HBsAg、抗-HBs和抗-HCV阳性之间无显著关联(P分别为0.205、0.872和0.676)。抗-HBs阳性与研究的最后四年之间存在直接关系(P<0.0001)。
观察到HBsAg的高流行率,高于评估地区的预期;抗-HCV的流行率与巴西当前现实一致;乙型肝炎免疫接种率可能较低,对这种感染的易感性相对较高,且未发现B和C病毒与HIV的合并感染病例。强调在产前检查中必须无一例外地追踪乙型和丙型肝炎,因为尽管目前治疗方面的进展可能无法治愈,但至少可以让慢性病患者有更好的生活质量,并确保所有新生儿强制性完成免疫预防。应特别关注那些易感染HBV的患者,及时诊断并转诊进行特异性疫苗接种。