丙型肝炎病毒抗体筛查在孕妇队列中的应用：确定血清流行率和危险因素。
Hepatitis C Virus Antibody Screening in a Cohort of Pregnant Women: Identifying Seroprevalence and Risk Factors.
机构信息
Departments of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, University of Texas Medical Branch at Galveston, Galveston, Texas, Brown University, Providence, Rhode Island, University of Utah Health Sciences Center, Salt Lake City, Utah, Columbia University, New York, New York, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, University of Alabama at Birmingham, Birmingham, Alabama, Duke University, Durham, North Carolina, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio, University of Texas Southwestern Medical Center, Dallas, Texas, Northwestern University, Chicago, Illinois, Stanford University, Stanford, California, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas, and Washington University in St. Louis, St. Louis, Missouri; the Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia; the George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
出版信息
Obstet Gynecol. 2020 Apr;135(4):778-788. doi: 10.1097/AOG.0000000000003754.
OBJECTIVE
To describe the prevalence of hepatitis C virus (HCV) antibody, evaluate current risk factors associated with HCV antibody positivity, and identify novel composite risk factors for identification of groups most likely to demonstrate HCV antibody seropositivity in an obstetric population from 2012 to 2015.
METHODS
The Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network initiated an observational study of mother-to-child transmission of HCV in 2012 that included offering HCV antibody screening to their entire obstetric population. Women presenting for prenatal care before 23 weeks of gestation without a known multifetal gestation were eligible. For each woman who was HCV antibody-positive, two women at similar gestational age who were HCV antibody-negative were identified and included for comparison. Risk factors were evaluated by patient interview and chart review. Women in the case group were identified to have a signal-to-cutoff value of at least 5 on the Abbott ARCHITECT platform. RNA status was evaluated for women in the case group.
RESULTS
Of 106,842 women screened for the HCV antibody, 254 had positive results. The HCV antibody seroprevalence rate was 2.4 cases per 1,000 women (95% CI 2.1-2.7). One hundred thirty-one women in the case group and 251 women in the control group were included in the case-control analysis. Factors associated with HCV antibody positivity included injection drug use (adjusted odds ratio [aOR] 22.9, 95% CI 8.2-64.0), blood transfusion (aOR 3.7, 95% CI 1.3-10.4), having a partner with HCV (aOR 6.3, 95% CI 1.8-22.6), more than three lifetime sexual partners (aOR 5.3, 95% CI 1.4-19.8), and smoking (aOR 2.4, 95% CI 1.2-4.6). A composite of any of these potential risk factors provided the highest sensitivity for detecting HCV antibody (75/82 cases, 91%).
CONCLUSION
In this cohort, the seroprevalence of HCV antibody was low, and the current risk factors for HCV screening were not identified. These findings may be useful in defining new strategies for identifying mothers with the HCV antibody and the neonates susceptible to maternal transmission of HCV.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov, NCT01959321.
目的
描述丙型肝炎病毒（HCV）抗体的流行情况，评估与 HCV 抗体阳性相关的当前危险因素，并确定新的复合危险因素，以识别 2012 年至 2015 年产科人群中最有可能出现 HCV 抗体血清阳性的人群。
方法
Eunice Kennedy Shriver 国立儿童健康与人类发展研究所母婴医学单位网络于 2012 年启动了一项 HCV 母婴传播的观察性研究，该研究对其整个产科人群进行了 HCV 抗体筛查。有资格参加研究的是在妊娠 23 周前就诊、无多胎妊娠史的孕妇。对于每一位 HCV 抗体阳性的妇女，都要找出两位在相似妊娠龄、HCV 抗体阴性的妇女作为对照。通过患者访谈和病历回顾评估危险因素。病例组的妇女被确定为 Abbott ARCHITECT 平台上的信号-截止值至少为 5。对病例组的妇女进行 RNA 状态评估。
结果
在接受 HCV 抗体筛查的 106842 名妇女中，有 254 名妇女的结果呈阳性。HCV 抗体血清阳性率为每 1000 名妇女 2.4 例（95%CI 2.1-2.7）。在病例组中，有 131 名妇女和对照组中，有 251 名妇女纳入病例对照分析。与 HCV 抗体阳性相关的因素包括注射吸毒（校正优势比[aOR]22.9，95%CI 8.2-64.0）、输血（aOR 3.7，95%CI 1.3-10.4）、伴侣 HCV 感染（aOR 6.3，95%CI 1.8-22.6）、终生性伴侣多于 3 人（aOR 5.3，95%CI 1.4-19.8）和吸烟（aOR 2.4，95%CI 1.2-4.6）。任何这些潜在危险因素的组合对检测 HCV 抗体具有最高的敏感性（75/82 例，91%）。
结论
在本队列中，HCV 抗体的血清阳性率较低，目前尚未确定 HCV 筛查的危险因素。这些发现可能有助于确定携带 HCV 抗体的母亲和易受 HCV 母婴传播影响的新生儿的新策略。
临床试验注册
ClinicalTrials.gov，NCT01959321。
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