Chen W H, Yin C S, Chang Y K, Yan J S, Chu M L
Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Int J Gynaecol Obstet. 1998 Jan;60(1):15-21. doi: 10.1016/s0020-7292(97)00223-3.
To elucidate possible routes and predictors of perinatal transmission of hepatitis B virus (HBV).
This was a prospective follow-up study. One hundred and forty-seven out of 1762 pregnant women who were screened in the antenatal clinic of a university teaching hospital were HBsAg carriers. Enzyme immunoassay was used for determination of hepatitis B markers. Occurrence of HBsAg in newborns' gastric aspirates, newborns' and infants' blood, and maternal milk samples were determined. Their relationship with delivery routes and duration of the first stage of labor were analyzed by chi square test.
The presence of HBsAg in newborns' gastric aspirates was strongly associated with the acquisition of HBsAg by the babies. There was no correlation between the rate of infant antigenemia and the duration of the first stage of labor, nor did cesarean section decrease the rate of vertical transmission of HBV.
This is the first report to provide direct evidence for the major role of the oral route in vertical transmission of HBV during delivery. In addition to maternal serum HBeAg, HBsAg status in newborn's gastric aspirates is another important determinant for vertical transmission of HBV.
阐明乙型肝炎病毒（HBV）围产期传播的可能途径及预测因素。
这是一项前瞻性随访研究。在一所大学教学医院的产前诊所接受筛查的1762名孕妇中，有147名是HBsAg携带者。采用酶免疫测定法检测乙肝标志物。测定新生儿胃吸出物、新生儿及婴儿血液以及母乳样本中HBsAg的出现情况。通过卡方检验分析它们与分娩途径及第一产程持续时间的关系。
新生儿胃吸出物中HBsAg的存在与婴儿获得HBsAg密切相关。婴儿抗原血症的发生率与第一产程的持续时间之间无相关性，剖宫产也未降低HBV垂直传播的发生率。
这是第一份为分娩期间经口途径在HBV垂直传播中的主要作用提供直接证据的报告。除了母亲血清HBeAg外，新生儿胃吸出物中的HBsAg状态是HBV垂直传播的另一个重要决定因素。
