慢乙肝母婴传播阻断和治疗策略的建议

Prevention of vertical transmission and treatment of chronic hepatitis B

慢性乙型肝炎患者感染HBV的主要途径为母婴传播,根据胎儿发育史,从分析母婴传播的可能机制入手,提出阻断母婴传播的措施应当是母婴共同进行免疫预防,即HBsAg(+)孕妇应从妊娠第16周开始,最迟不应晚于20wk,应进行每月1次的乙肝免疫球蛋白200IU肌注(若HBVDNA阳性也可以用400IU/次),直至分娩;娩出的新生儿应进行主动-被动联合免疫,即娩出24h(最好6h)内注射乙肝免疫球蛋白200IU,2wk后再重复一次,并同时进行疫苗接种,以期得到最佳保护效果.慢性乙型肝炎治疗以抗病毒为主,同时兼顾提高机体免疫的疗法,并提出以HBVDNA定量为基础的慢乙肝简单分类方法,便于推广应用.

Vertical transmission is the main path of hepatitis B virus （HBV） infection in patients with chronic hepatitis B （CHB）. According to the development history of embryo and the possible mechanism of vertical transmission, it＇s supposed that the effective method to prevent vertical transmission should be immunoprophylaxis in both mother and baby. Pregnant woman with positive HBsAg should receive monthly injection of 200 IU hepatitis B immunoglobulin （HBIg, or 400 IU once if HBV DNA is positive） from the 16^th week after pregnancy （at from the 20^th Week）. The newborn child should receive combined immunization （active/passive）, namely injection of 200 IU HBIg within 24 hours （better within 6 hours） after birth, and one more repeat after 2 weeks. HBV vaccination should be carried out at the same time in order to acquire the best protection result. The treatment of CHB mainly depends on antiviral therapy, and systemic immunization may also contribute to the efficacy of antiviral drugs. A simple classification method of CHB was suggested according to serum HBV DNA level in this article, which could be easily used in clinical practice.