Risk factors for subclinical mastitis among HIV-infected and uninfected women in Lusaka, Zambia
Risk factors for subclinical mastitis among HIV-infected and uninfected women in Lusaka, Zambia
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DOI：
10.1111/j.1365-3016.2006.00746.x
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发表时间：
2006-09-01
影响因子：
2.8
通讯作者：
Filteau, Suzanne
中科院分区：
文献类型：
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作者：
Kasonka, Lackson;Makasa, Mpundu;Filteau, Suzanne
亚临床乳腺炎定义为乳钠/钾（Na/K）比值升高，与婴儿生长不良有关，在感染艾滋病毒的妇女中，与乳中艾滋病毒载量增加有关。我们在赞比亚的卢萨卡进行了一项纵向队列研究，以调查几种潜在原因对亚临床型乳腺炎的相对重要性：母体感染、微量营养素缺乏和不良的哺乳实践。妇女（198名艾滋病毒感染者，189名艾滋病毒未感染者）在怀孕34周时被招募，并在产后16周内进行随访，以收集关于她们的健康、婴儿的健康、婴儿生长和婴儿喂养做法的信息。在11次产后访视时从每个乳房采集乳汁样本，在招募时和产后6周采集血液。HIV感染妇女的乳汁Na/K比值几何平均值以及一侧或双侧乳房Na/K比值> 1.0的妇女比例显著高于未感染妇女。在单变量分析中，与平均Na/K比值较高相关的其他因素包括产次、6周时母体α 1-酸性糖蛋白（AGP）高、母体总体发病率和特定乳房症状、早产、婴儿体重或身长低、婴儿鹅口疮和非纯母乳喂养。在多变量分析中，产次、早产、乳房症状、HIV感染和AGP升高与Na/K比值升高相关。因此，与适于干预的亚临床乳腺炎相关的主要因素是产妇总体健康和乳房健康状况差。改善产后保健，特别是孕产妇感染的管理，特别是在产妇，对亚临床乳腺炎的患病率及其后果的影响，需要调查。
Subclinical mastitis, defined as raised milk sodium/potassium (Na/K) ratio, is associated with poor infant growth and, among HIV-infected women, with increased milk HIV viral load. We conducted a longitudinal cohort study in Lusaka, Zambia, in order to investigate the relative importance of several potential causes of subclinical mastitis: maternal infection, micronutrient deficiencies and poor lactation practice. Women (198 HIV-infected, 189 HIV-uninfected) were recruited at 34 weeks' gestation and followed up to 16 weeks postpartum for collection of information on their health, their infant's health, infant growth and infant feeding practices. Milk samples were collected from each breast at 11 postpartum visits and blood at recruitment and 6 weeks postpartum.The geometric mean milk Na/K ratio and the proportion of women with Na/K ratio > 1.0 in one or both breasts were significantly higher among HIV-infected than among uninfected women. Other factors associated with the higher mean Na/K ratio in univariable analyses were primiparity, high maternal alpha(1)-acid glycoprotein (AGP) at 6 weeks, maternal overall morbidity and specific breast symptoms, preterm delivery, low infant weight or length, infant thrush and non-exclusive breast feeding. In multivariable analyses, primiparity, preterm delivery, breast symptoms, HIV status and raised AGP were associated with the raised Na/K ratio. Thus the main factors associated with subclinical mastitis that are amenable to intervention are poor maternal overall health and breast health. The impact of improved postpartum health care, especially management of maternal infections and especially in primiparous women, on the prevalence of subclinical mastitis and its consequences requires investigation.