Mechanisms and Prevention of Vertical Transmission in Chronic Viral Hepatitis.
Mechanisms and Prevention of Vertical Transmission in Chronic Viral Hepatitis.
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DOI：
10.14218/jcth.2016.00067
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发表时间：
2017-06-28
影响因子：
3.6
通讯作者：
Wu GY
中科院分区：
文献类型：
--
作者：
Mavilia MG;Wu GY
垂直传播（VT）是儿童病毒性肝炎的主要传播途径。B型肝炎病毒（HBV）的VT发生率为1-28%，丙型肝炎病毒（HCV）的VT发生率为3-15%。这两种病毒的VT可发生在宫内或围产期。HBV的VT主要通过宫内传播（IUT）发生。B型肝炎表面抗原不能穿过胎盘，因此依赖于经胎盘渗漏、胎盘感染、外周血单核细胞的细胞传播和生殖系传播等过程。HCV也可以通过IUT感染胎儿。这两种病毒也有可能在分娩过程中传播，因为母婴血液接触的机会增加。HBV和HCV有一些共同的VT危险因素，包括母体病毒载量、人类免疫缺陷病毒合并感染和新生儿性别。预防VT在HBV和HCV之间有很大不同。有几种预防HBV VT的替代方案，包括妊娠晚期的抗病毒药物和乙型肝炎疫苗，以及产后婴儿的B型肝炎免疫球蛋白给药。相比之下，没有针对HCV的预防性干预措施。尽管存在这些差异，但预防这两种病毒的关键是在怀孕前和怀孕期间对妇女进行筛查。
Vertical transmission (VT) is the primary route of transmission of viral hepatitis in children. The rate of VT ranges from 1–28% with hepatitis B virus (HBV) and 3–15% with hepatitis C virus (HCV). VT for both viruses can occur during the intrauterine or peripartum period. VT of HBV primarily occurs by intrauterine transmission (IUT). Hepatitis B surface antigen is unable to cross the placenta and, therefore, relies on processes like transplacental leakage, placental infection, cellular transmission by peripheral blood mononuclear cells, and germline transmission. HCV can also infect the fetus by IUT. Both viruses also have the potential for transmission during delivery, when there is increase chance of maternal–fetal blood exposure. HBV and HCV share some common risk factors for VT, including maternal viral load, human immunodeficiency virus co-infection and neonatal sex. Prevention of VT differs greatly between HBV and HCV. There are several alternatives for prevention of HBV VT, including antiviral medications during the third trimester of pregnancy and HBV vaccine, as well as hepatitis B immunoglobulin administration to infants post-partum. In contrast, there are no preventative interventions available for HCV. Despite these differences, the key to prevention with both viruses is screening women prior to and during pregnancy.