阻断乙型肝炎病毒宫内传播的初步研究

A PRELIMINARY STUDY ON INTERRUP-TION OF HBV TRANSMISSION IN UTERO

宫内已感染乙型肝炎病毒（ＨＢＶ）是新生儿接种乙肝疫苗免疫失败的主要原因。为了减少新生儿产前在宫内受ＨＢＶ感染，提高乙肝疫苗接种后的免疫效果，研究给予阻断措施和观察其效果。从３６３２名孕妇筛查出ＨＢＶ无症状携带者２０４例，随机分为二组，即临产前３个月每月注射１次乙型肝炎免疫球蛋白（ＨＢＩＧ），每次２００ＩＵ，和不注射者作对照。在孕妇分娩后和新生儿出生时分别抽外周血作血清学检测。结果显示，ＨＢＩＧ组和对照组所生新生儿的宫内感染率分别是５．７％和１４．７％（Ｘ￣２＝４．５８，Ｐ＜０．０５）。分娩后二组孕妇的ＨＢｓＡｇ和ＨＢｅＡｇ的阳性率无差异，但ＨＢＩＧ组ＨＢｓＡｇ阳性滴度的均值显著低于对照组（ｔ＝４．８２，Ｐ＜０．０１）。提示产前多次肌注ＨＢＩＧ可减少携带ＨＢＶ母亲所生新生儿宫内受ＨＢＶ感染。这可能与产时减少母体外周血中的ＨＢＶ有关。接受ＨＢＩＧ在分娩前后的随访无不良反应。

n utero hepatitis B virus (HBV) infection is themajor cause of failure of vaccination against hepatrtis Bin neonates born to HBV carrier mothers. We studiedthe interruptive effect of HBV-specific immunoglobulin(HBIG) in the prevention of intrauterine transmissionof HBV. Two hundred and four of 3632 pregnantwomen, who were HBV carriers, were randomly as-signed to HBIG group and a control group; each sub-ject in HBIG group received 200 IU of HBIG intramus-cularly at 3.2 and 1 month before dehvery and the sub-jects in control group did not receive any specific treat-ment. Blcod tests were performed for all the subjectsand their neonates after birth. The resuhs showed thatthe rates of intrauterine transmission in the two groupswere 5. 7% and 14. 7% respectively. No significantdifferences were observed for the positive rates of HB-sAg and HBeAg between the two groups after deliv-ery, but the titer of HBsAg was reduced significantlyin HBIG group. Our study suggest that HBV infectionin utero may be interrupted by using multiple intramuscular HBIG before delivery without any side effects.