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建议怀孕期间做丙肝筛查

By LabMedica International staff writers
Posted on 10 Jan 2018
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图片:感染活跃丙肝病毒的肝的组织病理图(图片蒙加利福尼亚太平洋医疗中心惠赐)。
图片:感染活跃丙肝病毒的肝的组织病理图(图片蒙加利福尼亚太平洋医疗中心惠赐)。
尽管有人提出美国产前丙肝病毒(HCV)感染的发生率高达4%,然而它的实际估值很低,只有约1%-2.5%,有些人引述普查的性价比缺乏数据支持,因此不主张对所有孕妇做丙肝筛查。

美国首都华盛顿特区母婴医学学会(SMFM)的新指导意见建议对丙肝病毒(HCV)感染风险高的孕妇做彻底检验,并给出了一组筛查丙肝的处方性建议。同在华盛顿特区的美国妇产科医师学会(ACOG)审议了这份指导意见并为其背书。

该指导意见建议对携带某些高风险因子(如吸毒、不规范纹身、长期血透或监禁史、接受后来检查出丙肝阳性的献血者的血液制品)的妇女做产前丙肝检验。1992年7月前接受输血或器官移植以及接受1987年前生产的浓缩凝血因子的妇女也应接受筛查。应在初次产前门诊时筛查高风险患者,如果在后来的某个时候出现新的或持续性的丙肝因子,如鼻吸或注射违禁药物,那么即使初次检验结果为阴性,也有必要进行二次筛查。

临床医师用抗丙肝抗体试验筛查丙肝。阳性结果可能意味着下列可能性之一:急性或慢性丙肝感染,过去的感染后来治愈,或者是假阳性。SMFM和ACOG建议对丙肝抗体试验结果阳性者进行HCV RNA定量核酸检验。SMFM和IDSA的其它筛查建议有:临床医师对接触丙肝病毒且抗丙肝抗体试验结果呈阴性的患者做6个月的随访,随访期内进行HCV RNA检验。它之所以必要是因为初次检验时可能检测不到这些抗体。

还应检验丙肝阳性孕妇是否有HIV、梅毒、淋病、衣原体、丙肝病毒等性传播疾病。应该通知要求做创伤性产前诊断检验的患者,告诉她们揭示垂直传播风险的数据有限,羊膜穿刺比绒膜绒毛采样更可取。其它建议还有:不要依靠剖腹产来检验丙肝病毒。

该指导意见发表于2017年11月号的《美国妇产科杂志》(American Journal of Obstetrics and Gynecology)。领衔作者、母婴医学专家Brenna Hughes大夫说:“根据什么决定诊断婴儿的时机与下述事实相关,母体的抗体可能在婴儿体内存活数月,导致假阳性诊断。另一种可能是婴儿可能清除来自母亲的病毒,所以要求一个月大后做两次HCV RNA检查是为了避免假阳性诊断。”

Related Links:
母婴医学学会
美国妇产科医师学会

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