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肝炎病毒与新生儿：临床表现和治疗

Author
Donough J O'Donovan, MD
Section Editors
Leonard E Weisman, MD
Sheldon L Kaplan, MD
Elizabeth B Rand, MD
Deputy Editor
Alison G Hoppin, MD
Translators
何振娟, 主任医师

引言

新生儿肝炎病毒感染通常是受感染的母亲垂直传播引起。围生期或新生儿期获得性感染的风险及其临床表现和可能的临床结果，因嗜肝病毒的不同而有所差异，本文将总结相关内容。

甲型肝炎

甲型肝炎病毒(hepatitis A virus, HAV)是一种直径为27nm、无包膜的RNA病毒，属于微小RNA病毒科。该病毒经粪-口途径通过人与人之间接触传播。这种感染具有高度传染性，共同接触污染的食物和水通常是疾病流行的原因。 (参见“儿童甲型肝炎病毒感染的概述”和“成人甲型肝炎病毒感染概述”)

传播

母体垂直传播

宫内传播 — 大多数情况下，妊娠女性的HAV感染都具有自限性。虽然母体HAV感染似乎并不会增加先天畸形、死产、宫内生长受限或自然流产的风险[1,2]，但能增加早产和胎膜早破的风险。 (参见“妊娠期间发生的肝胆疾病”，关于‘甲型肝炎’一节)

尽管罕见，但还是有2例在妊娠较早阶段发生HAV宫内传播的病例报道[3,4]。这些病例都表现为胎儿腹水和胎粪性腹膜炎。分娩后，血清学检查证实这两例婴儿都存在HAV感染，并且他们都因胎粪性腹膜炎而需要手术干预；而后，均顺利康复。

围生期传播 — 目前有数份病例报告称，在分娩前数周或分娩时发生HAV垂直传播[5-7]。其中大多数婴儿是在新生儿期后表现出肝炎时，才发现存在垂直传播。尽管有这些报告，但鉴于HAV感染在全球范围内广泛分布的情况，围生期传播的风险很低。

                             

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Literature review current through: 2017-06 . | This topic last updated: 2016-10-31.
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