乙型肝炎病毒的母婴阻断977例1年随访研究

Study on interruption of maternal-infantile transmission of HBV:a one-year follow-up of 977 cases.

目的 探讨对乙型肝炎表面抗原 (HBsAg)阳性母亲分娩新生儿实施母婴阻断的最佳方案 ,探索免疫失败的原因及对策。方法 通过总结东南大学医学院附属南京第二医院 1985～ 2 0 0 3年 32 0 0例HBsAg阳性母亲分娩新生儿实施母婴阻断后的血清乙型肝炎病毒 (HBV)标志物资料 ,根据不同阻断方案分成 5组 :血源疫苗组(第 1组 )、血源联合组 (第 2组 )、基因疫苗组 (第 3组 )、基因联合组 (第 4组 )和宫内阻断组 (第 5组 )。其中共 977例婴儿随访至 12个月龄。观察、比较各组婴儿出生时及 1、6、12个月龄时的HBsAg、乙型肝炎表面抗体 (HBsAb)的阳性率。结果 第 5组 12个月龄时HBsAg阳性率仅为 4 0 % ,保护率达 96 0 % ,与前 4组比较差异有显著性意义 (P <0 0 5或P <0 0 1)。第 4、5组比较 ,出生时HBsAb检出率分别为 8 3%、81 0 % ,差异有显著性意义(P <0 0 1) ;宫内感染率分别为 5 1 7%、32 0 % ,差异有显著性意义 (P <0 0 5 ) ;免疫失败率为 19 4 %、12 5 % ,差异有显著性意义 (P <0 0 5 )。第 2、4组 12个月龄时HBsAg的阳性率分别低于第 1、3组 ,HBsAb阳性率高于第 1、3组 ,差异有显著性意义 (P <0 0 5 )。双阳组、单阳组母亲分娩新生儿 12个月龄时HBsAg的阳性率分别为2 0 1%、7 8% 。

Objective To investigate the best way to break up maternal-infantile transmission of HBV and explore the causes and strategies of immunization failure. Methods From 1985 to 2003,3200 infants from HBsAg(+) mothers in the Second Affiliated Ho spital,South-east Medical University received various protective methods and were asked to have blood samples collected at 0,1,6,12 months after b irth respectively.They were divided into 5 groups according to 5 different prote ctive methods,totally 977 of 3200 cases were followed up to 12 months of age.We observed and compared their HBsAg,anti-HBs positive rates.Results The positive rate of HBsAg (4.0%) of the 5th group was lower while the positive rate of Anti-HBs (96.0%) was higher than that of the other 4 groups(P<0. 01,P<0.05,respectively).The detection rate of anti-HBs in newborns was sig nificantly highe r in the 5th group than that in the 4th group(81.0%,8.3%,P<0.01).The i ncidence of intrauterine HB V infection of the 5th group was much lower than that of the 4th group(32.0%,51 .7%,P<0.05).The protective efficacy of the secon d and 4th group was better than that of the first and third group(P<0.05).T h e positive rate of HBsAg of infants from both HBsAg and HBeAg positive mothers w as 20.1%, while it was 7.8% from only HBsAg positive mothers(P<0 .01).Conclusion Among the 5 methods,the 5th method,that is, intrauterine interruption, was the m ost effective,and vaccine combining HBIG was prior to vaccine only.The maternal-infantile transmission of HBV is relate d to mothers' positiveness of HBeAg and HBV-DNA.Immunization failure may be due to intrauterine infection which may be prevented by multiple H BIG injection before delivery.