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HBs 항원 양성 산모의 출생아에서의 경태반 감염에 관한연구

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 Transplacental transmission of hepatitis B virus from carrier mothers to neonates 
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[영문] [한글] B형 간염 항원 양성 산모로부터 B형 간염 바이러스가 주산기에 신생아로 감염되는 율은 약 50%라고 되어있고 우리나라 산모들의 6-9%가 B형 간염 보균산모로 밝혀져있다 본 연 구에서는 B형 간염 산모에서 신생아로 분만중이나 분만전에 태반을 통한 B형 간염의 전파 빈도를 알아 보고자 하였다. 1986년 9월부터 1989년 12월사이 연세대학교 의과대학 영동세브란스 병원에서 산전관리 를 받은 2972명의 산모중 HBs 항원이 양성으로 밝혀진 산모는 170명(5.7%)이었다. 이들 1 70명의 산모에서 태어난 신생아를 대상으로 출생후 3시간내에 경정맥을 이용하여 정맥혈 에서 B형 간염 바이러스 표식자 (HBsAg, anti-HBs, anti-HBc IgM)를 검사하였다. HBs 항 원은 대상 신생아 170명중 24명이 양성으로 나와 14.1%의 양성율을 보였고 HBs 항원의 평 균치는 2496.7± 5640.7cpm이어서 평균 cutoff치인 213.2±86.3cpm 보다 12배 높았다. 대상 신생아 전체에서 실시한 anti-HBc IgM은 1명 (0.6%)에서만 양성으로 나타났다. 출생 방법에 있어서 제왕절개를 한 경우 질식분만보다 HBs 항원양성율이 낮으나 통계학 적으로 유의한 차이는 없었다. 질식분만의 경우 진통의 기간이나 진통 단계는 신생아에서 HBs 항원 양성율에 영향을 미치지 못하였다. 대조군과 HBs 항원 양성 산모로부터 출생한 신생아간의 임신 주수, 1분 및 5분의 APGAR 점수, 출생시 체중, 신장, 흉위, 두위의 차이는 없었으며, 선천성 기형의 발생빈도도 두 군간에 차이가 없었다. Transplacental transmission of hepatitis B virus from carrier mothers to neonates Soh Yeon Kim Department of Medical Science The Graduate School, Yonsei University (Directed by Professor Chul Lee, M.D., PhD.) The rate of perinatal infection from hepatitis B carrier mothers to neonates is said to be about 50% and the incidence of carriers among pregnant women is said to be 6-9% in Korea. As the exact incidence of perinatal transmission of hepatitis B virus has not yet been determined, the anthers have tried to determine the frequency of transplacental hepatitis B viral transmission in neonates born to hepatitis B carrier mothers. Neonates born to hepatitis B carrier mothers at YongDong Severance Hospital, Yonsei University College of Medicine were sampled for hepatitis B viral markers using venous blood drawn from external jugular vein within 3 hours after birth and the following resulte were obtained. Two thousand nine hundred and seventy two pregnant women who received prenatal care at YongDong Severance Hospital, Yonsei University College of Medicine between September 1986 and December 1989 were tested for HBsAg and among them, 170(5.7%) were found to be positive. Among the 170 neonates born to these mothers, 24 were positive for HBsAg showing a 14.1% positive rate. The average antigen titer in these infants was 2496.7±5640.7cpm which was 12 times higher than the cutoff titer of 213.2±86.3cpm. Anti-HBc IgM was positive in 1(0.6%) among these 170 neonates. Anti-HBs was positive in 17 of the 170 neonates born to hepatitis B virus carrier mothers indicating a 10% positivity for anti-HBs. The incidence of hepatitis B virus infection was lower in neonates born by cesarian section than by normal vaginal delivery. However there was no significance in the difference between the two methods of delivery. The duration of labor and stages of labor in vaginal delivery had no relation to hepatitis B antigen positivity. There was no difference between the neonates born to carrier mothers and in the control group for duration of pregnancy, APGAR score at 1 and 5 minutes, weight, height, head and chest circumference and presence of congenital anomalies at birth. It can be concluded that the transplacental transmission rate of HBsAg in neonates born to HBsAg carrier mothers is 14.1%. Anti- HBc IgM was positive in 1 among 170 neonates indicating the possibility of intrauterine infection in neonates of hepatitis B carrier mothers.
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