Meta analysis of mother-to-child transmission of HBV by amniocentesis
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摘要:
目的 母婴乙肝病毒垂直传播已成为我国乙肝病毒感染的主要途径,本研究分析乙肝病毒感染的孕妇进行羊膜腔穿刺是否增加母婴垂直传播的风险。 方法 搜索1990年1月1日~2016年3月15日之间在Pubmed、Embase、谷歌学术和万方数据库等数据库中所有关于乙肝孕妇行羊膜腔穿刺对母婴垂直传播影响的相关英文或中文文章,根据纳入剔除标准对文章进行筛选,然后对文章治疗评分,最后有4篇文章纳入,共有3997孕妇,其中实验组167名、对照组3830名,使用Review Manager Version 5.0进行数据分析。 结果 荟萃分析结果显示,进行羊膜腔穿刺术与不行羊膜腔穿刺术两组婴儿HBsAg阳性率无明显差异(R2=1.37,95% CI: 0.70~2.69,P=0.36)。当孕妇是HBV-DNA≥107 copies/mL、HBeAg阳性时,进行羊膜腔穿刺术后胎儿宫内感染风险增加(R2=9.54,95% CI: 3.52~25.85,P<0.0004;R2=3.41,95% CI: 1.05~11.13,P=0.04)。 结论 孕妇HBV-DNA≥107 copy/mL和(或)HBeAg阳性时将增加母婴垂直传播的风险。 Abstract:Objective To explore if amniocentesis in pregnant with HBV infection carriers will increase the risk of mother-to-child transmission(MTCT). Methods All relevant published papers and abstracts of English and Chinese were searched by the key words such as hepatitis B virus/HBV, amniocentesis, vertical/mother-to-child transmission in Pubmed (MEDLINE), Embase, Google scholar and Wanfang database between January 1 1990 and March 15 2016. Four papers with 3997 pregnant women including 167 amniocentesis cases and 3830 control cases were entered to this analysis. The analysis was performed by statistical software Review Manager Version 5.0. Results The meta-analysis showed that there was no significant difference of infant’s HBsAg-positive rate between two groups of mothers who underwent amniocentesis or no amniocentesis (R2=1.37, 95% CI: 0.70~2.69, P=0.36). It increased the risk of MCTC of HBV if amniocentesis was performed in pregnant women with serum HBV-DNA≥107 copies/mL (R2=9.54, 95% CI: 3.52~25.85, P<0.0004) and/or HBeAg-positivity (R2=3.41, 95% CI: 1.05~11.13, P=0.04). Conclusion Amniocentesis in pregnant women with serum HBV-DNA ≥107 copies/mL and/or HBeAg-positivity would increase the risk of MTCT in HBV infection. -
Key words:
- amniocentesis /
- mother to child transmission /
- chronic hepatitis B /
- HBV /
- meta-analysis
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表 1 纳入文献基本信息
第一作者,发表年份 治疗 新生儿免疫 新生儿HBV感染率 羊水穿刺组 对照组 HBIG U 乙肝疫苗(μg) HBsAg阳性 HBV DNA阳性 24 h 6~12个月 24 h 6~12个月 Ko[8] 1994 肝功能正常,6个月内未接受抗病毒或免疫治疗的单胎孕妇,具备侵入性产前诊断指征,知情同意接受羊膜腔穿刺术 未进行羊水穿刺,HBV DNA拷贝数无限制 产后6 h内及产后1个月,200 U/次 产后0、1、6月,10 μg/次 1/35:2/65 3/32:380/3454 — — 郝(hao)[9] 2011 肝功能正常,6个月内未接受抗病毒或免疫治疗的单胎孕妇,具备侵入性产前诊断指征,知情同意接受羊膜腔穿刺术 未进行羊水穿刺,HBV DNA阴性的HBV感染孕妇 产后6 h内及产后1个月,200 U/次 产后0、1、6个月,20 μg/次 0/31:0/43 0/31:0/43 0/31:0/43 0/31:1/43 Yi[10] 2014 肝功能正常,6个月内未接受抗病毒或免疫治疗的单胎孕妇,具备侵入性产前诊断指征,知情同意接受羊膜腔穿刺术 未进行羊水穿刺,HBV DNA拷贝数无限制 产后6 h内及产后1个月,200 U/次 产后0、1、6个月,10 μg/次 11/63:47/198 4/63:5/198 3/63:11/198 — 陈(chen)[11] 2014 肝功能正常,6个月内未接受抗病毒或免疫治疗的单胎孕妇,具备侵入性产前诊断指征,知情同意接受羊膜腔穿刺术 未进行羊水穿刺,HBV DNA拷贝数无限制 产后6 h内及产后15 d,200 U/次 产后0、1、6个月,10 μg/次 — — — 3/41:4/137 表 2 入组病例对照研究文章根据NEWCASTLE-OTTAWA(NOS)文献质量评价量表评分情况
第一作者,发表年份 选择 可比性 结局 总分 暴露队列代表性 非暴露组选择 暴露的确定 研究前研究对象发生结局事件 控制1个重要混杂因素(1分)控制2个或以上(2分) 结局事件的评估 随访是否充分 随访完整性 Ko 1994 0 0 1 1 0 1 1 1 5 郝(hao)2011 1 1 1 1 0 1 1 1 7 Yi 2014 1 1 1 1 2 1 1 1 9 陈(chen) 2014 1 1 1 1 0 1 1 1 7 表 3 文献方法学质量评价
第一作者,发表年份 随机方法 隐蔽分组 盲法 不完整治疗 选择性报告偏移 其他偏移来源 Ko 1994 否(根据患者意愿) 否 否 完整 否 否 郝(hao)2011 否(根据患者意愿) 否 否 完整 否 否 Yi 2014 否(根据患者意愿) 否 否 完整 否 否 陈(chen) 2014 否(根据患者意愿) 否 否 完整 否 否 表 4 文献的基本情况
编号 作者 干预组样本 对照组样本 1 Ko 32 3454 2 郝 31 47 3 Yi 63 198 4 陈 41 137 -
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