联合免疫后乙肝病毒携带产妇母乳喂养安全性的探讨

Risk of HBV transmission in breast-fed infants of chronic HBV carriers after combination immunoprophylaxis.

目的:探讨主被动联合免疫后乙肝病毒(HBV)携带产妇的婴儿接受母乳喂养的安全性。方法:前瞻性追踪115例孕晚期注射高效价乙肝免疫球蛋白(HB IG)的HBV携带产妇乳汁中HBV感染性标志物(HBVM)、HBV-DNA和新生儿外周血HBVM情况,以及接受联合免疫后母乳或人工喂养7月龄婴儿血HBVM情况。其中母乳喂养组婴儿70例,人工喂养组45例。结果:2组新生儿HBV感染率分别为11.4%和13.3%,2组婴儿母亲外周血HBeAg阳性率分别为31.4%和31.1%,差异均无统计学意义。母乳喂养组和人工喂养组产妇初乳中HBsAg阳性率分别为34.3%和40.0%,HBeAg阳性率分别为28.6%和26.7%,2组产妇初乳中HBsAg阳性率、HBeAg阳性率和HBV-DNA滴度比较,差异均无统计学意义。母乳喂养组和人工喂养组7月龄婴儿HBV感染率分别为5.7%和8.9%,抗HBs阳性率分别为85.7%和84.4%,2组比较差异均无统计学意义。结论:在进行多重联合免疫干预后,HBV携带产妇母乳喂养并不增加HBV母婴传播的风险。

Objective：To explore the risk of HBV transmission in breast-fed infants of chronic HBV carriers after combination immunoprophylaxis. Methods ：Since 2001 ,information on chronic HBV cartier mothers and their infants had been collected in a prospective longitudinal study. They all participated in a HBV immunoprophylaxis program. HBV infectious markers were detected in colostrums of mothers and in serum of newborns. Infants were followed up to 7 months and examined for HBV infectious markers again. Results：Seventy breast-fed infants with 45 formula-fed infants were compared. There was no statistically difference between the two groups with respect to the HBV-infectious rate of newborns （ 11.4% vsl3.3% ） and the positive rate for HBeAg of mothers （31.4% vs 31.1% ）. The positive rates for HBsAg,HBeAg and HBV-DNA in colostrums were not statistically different between the two groups, either. Followed up for 7 months,the HBV-infectious rates for breast-fed infants and formula-fed infants were 5.7% and 8. 9% respectively. The anti-HBs positive rates of the two groups were 85. 7% and 84.4% , respectively. There were no significant differences for the HBV-infectious rates and the anti-HBs positive rates between the two groups. Conclusion： With combination immunoprophylaxis, breastfeeding of infants of chronic HBV carriers poses no additional risk for the transmission of HBV.