McQuillan G M, Townsend T R, Johannes C B, Dillard T, Molteni R A, Ness P M, Niebyl J R
Am J Epidemiol. 1987 Sep;126(3):484-91. doi: 10.1093/oxfordjournals.aje.a114680.
The Advisory Committee on Immunization Practices recommends that all pregnant women be questioned concerning risk factors for hepatitis B virus infection and that those giving positive responses be serotested. The sensitivity, specificity, and predictive value of those recommended questions among 692 parturient women were determined. A total of 59 currently or previously infected women (hepatitis B surface antigen (HBsAg), antibody to hepatitis B surface antigen (anti-HBs), or antibody to hepatitis B core antigen (anti-HBc) seropositive) were compared with the 633 seronegative women. Among nonwhite women, the sensitivity of a positive response to any one of the recommended questions was 60%. Specificity and positive predictive value were 71% and 19%, respectively. Among white women, the sensitivity, specificity, and positive predictive value were 56%, 75%, and 11%, respectively. To increase such unacceptably low sensitivity, the authors included two additional questions: single marital status and Medicaid/medical assistance payer status. Sensitivity increased to 96% among nonwhite women and 84% among white women. However, a positive response to at least one of the recommended questions or to additional questions was elicited from 78% of all women (92% nonwhite and 64% white). The authors conclude that to prevent perinatal transmission of hepatitis B, we must serotest all women in our obstetric population.
免疫实践咨询委员会建议，应对所有孕妇询问有关感染乙型肝炎病毒的危险因素，并对回答呈阳性的孕妇进行血清检测。研究确定了692名产妇中那些推荐问题的敏感性、特异性和预测价值。将总共59名目前或既往感染的妇女（乙型肝炎表面抗原（HBsAg）、乙型肝炎表面抗原抗体（抗-HBs）或乙型肝炎核心抗原抗体（抗-HBc）血清学阳性）与633名血清学阴性的妇女进行了比较。在非白人妇女中，对任何一个推荐问题回答阳性的敏感性为60%。特异性和阳性预测值分别为71%和19%。在白人妇女中，敏感性、特异性和阳性预测值分别为56%、75%和11%。为提高这种低得令人无法接受的敏感性，作者增加了两个额外问题：单身婚姻状况和医疗补助/医疗救助支付者状况。非白人妇女的敏感性提高到96%，白人妇女提高到84%。然而，所有妇女中有78%（非白人92%，白人64%）对至少一个推荐问题或额外问题回答呈阳性。作者得出结论，为预防乙型肝炎的围产期传播，我们必须对产科人群中的所有妇女进行血清检测。
