乙型肝炎病毒携带者母乳喂养的研究

Study on breast-feeding in hepatitis B virus carrier women

目的 探讨乙型肝炎 (乙肝 )病毒 (hepatitisBvirus ,HBV)携带者在其新生儿、婴儿接受被动及主动全程联合免疫的条件下 ,是否可以母乳喂养。 方法 对 2 0 0 1年 9月至 2 0 0 3年 10月间妊娠期无症状HBV携带者所娩婴儿进行前瞻性随访研究 ,新生儿出生时留取脐血检测HBV脱氧核糖核酸 (HBVDNA) ,出生后 12h内及第 14天注射乙肝免疫球蛋白 ,并按 0、1、6的程序全程接种乙肝疫苗 ,由产妇自愿选择母乳喂养或人工喂养 ,5 5例母乳喂养 ,3 6例人工喂养。分别于婴儿 7个月和 12个月时随访检测HBVDNA及乙肝血清标志物 ,婴儿 7个月时未感染乙肝但抗 HBs阴性者给予乙肝疫苗 5 μg加强注射。 结果 婴儿 7个月和 12月时 ,母乳喂养组HBVDNA阳性率分别为 9.0 9% (5 /5 5 )及 9.0 9% (5 /5 5 ) ,抗HBs阳性率分别为 85 .45 % (4 7/5 5 )及 90 .90 % (5 0 /5 5 ) ;人工喂养组HBVDNA阳性率分别为 8.3 3 % (3 /3 6)及 8.3 3 % (3 /3 6) ,抗HBs阳性率分别为 86.11% (3 1/3 6)及 91.67% (3 3 /3 6)。母乳喂养与人工喂养相比 ,差异均无统计学意义。 结论 在新生儿、婴儿接受被动及主动全程联合免疫的条件下 ,无症状HBV携带者可以母乳喂养。

Objective To explore the possibility of breast feeding in chronic asymptomatic hepatitis B virus (HBV) carriers after immuno prophylaxis of the infants. Methods The infants with asymptomatic HBV carriers mothers were selected by the obstetric department of Qilu Hospital of Shangdong University, Jinan Maternity and Infant Health Institute of Shangdong from Sept 2001 to Oct 2003 prospectively. Umbilical blood HBV deoxyribonucleic acid (HBV DNA) was detected at birth. All infants received 200 IU HBV specific immunoglobin(HBIG)within 12 hours and on 14 days after birth. The hepatitis B recombinant vaccine was given within 24 hours after birth and at 1 and 6 months of age. The way of feeding was chosen by the mothers as they liked. There were 55 infants in breast feeding group and 36 in bottle feeding group. Infants were then followed up at 7 and 12 months of age and tested for hepatitis B surface antigen(HBsAg), hepatitis B surface antibody (anti HBs), hepatitis B e antigen(HBeAg), hepatitis B e antibody(anti HBe) and hepatitis B core antibody(anti HBc) and HBV DNA. Uninfected infants with negative anti HBs were given repeated dose of vaccinations. Results At 7 and 12 months of age, the positive rates of HBV DNA were 9.09%(5/55)and 9.09%(5/55), anti HBs were 85.45%(47/55)and 90.90%(50/55)in breast feeding group respectively;while the positive rates of HBV DNA were 8.33%(3/36)and 8.33%(3/36), anti HBs were 86.11%(31/36)and 91.67%(33/36)in bottle feeding group respectively. No significant differences was shown in positive rates of HBV DNA and anti HBs between these two groups. Conclusions With appropriate immunoprophylaxis, including hepatitis B immune globulin and hepatitis B vaccine, HBV carriers can breast feed their babies.