产前注射HBIG及新生儿HBIG联合乙肝疫苗预防乙肝病毒母婴传播

The Prevention of Maternal-infant Vertical Transmission of HBV by Intramuscular Injection of HB Immunoglobulin During Pregnancy and Combined Use of HBIG and HB Vaccine to Infants

目的:探讨乙肝表面抗原(HBsAg)阳性母亲产前用乙肝免疫球蛋白(HBIG)及婴儿HBIG联合乙肝疫苗阻断母婴传播的效果。方法:2004年1月至2006年4月在江西省妇幼保健院产前检查、住院分娩的HBsAg阳性孕妇366例,研究组186例(HBsAg及HBeAg双阳性66例),对照组180例(HBsAg及HBeAg双阳性60例)。研究组于28、32、36周肌肉注射HBIG200 IU,共3次,对照组不用药。所有新生儿出生时采静脉血1 mL,出生后24 h内注射HBIG200 IU,按0,1,6个月龄接种乙肝疫苗,5μg/次,随访至1岁时采婴儿静脉血1 mL,采用酶联免疫法检测新生儿出生时和1岁时静脉血清HBsAg、HBsAb、HBeAg、HBeAb、HBcAb,采用核酸扩增(PCR)荧光定量检测HBV-DNA含量。结果(1)研究组宫内感染率4.3%,明显低于对照组10.6%,两组比较差异有显著性意义(χ2=5.237,P<0.05);(2)研究组新生儿血清抗-HBs阳性率20.4%,明显高于对照组3.3%,差异有极显著意义(χ2=25.28,P<0.01);(3)研究组婴儿HBV感染率1.1%,明显低于对照组7.2%,两组比较差异有极显著性意义(χ2=7.3,P<0.01)。结论:产前用HBIG和新生儿HBIG联合乙肝疫苗免疫可降低慢性HBV感染率,阻断宫内感染的慢性化,提高产时感染的阻断效果。

Objective：To investigate the preventive effect of HB immunoglobulin（HBIG） and combined use of HBIG and HB vaccine on vertical transmission of HBV by HbsAg-positive mothers to infants. Methods ： From Jan. 2004 to Apr. 2006,366 cases of pregnant women with HBsAg positive were divided into two groups： study group （n = 186） and control group（n=180）. The study group was intramuscularly injected 200 IU of HBIG at the 28th,32th,36th week,while the con- trol group was not. All their infants were injected with HBIG 200 IU at birth and three 5 μg doses of recombinant vaccine were given at 0,1 and 6 month. HbsAg, HBeAg, anti- HBs, anti-Be, anti-Bc and HBV-DNA load at the newborns and the age of 12 months were tested respectively by using enzyme linked immunosorbant assay （ELISA） and polymerase chain reaction （PCR）. Results： （ 1 ） the HBV intrauterine infection rate of the study group was significantly lower than that of the control group（x^2 =5. 237, P〈0.05）. （2）The anti-HBs positive rate of the infants in the study group was significantly higher than that in the control group （x^2 = 25.28, P^0.01）. （3） The chronical infection rate of HBV of infants in study group was significantly lower than that in the con- trol（x^2= 7.3,P〈0.01）. Conclusion： Use of HBIG to HBsAg positive mothers during pregnancy and combined use of HBIG and HB vaccine to infants could block the chronicity of HB resulted from intrauterine infection.