被动免疫对HBV携带孕妇母婴传播及乳汁中HBVM的影响

Influence of HBV maternal-infant transmission for chronic HBV carriers after passive immunoprophylaxis

目的探讨高效价乙肝免疫球蛋白(HB IG)被动免疫对乙肝病毒(HBV)母婴传播及HBV携带孕妇初乳中HBV感染性标志物(HBVM)的影响。方法将326例HBV携带而肝功能正常的孕妇按知情自愿原则分成2组,其中实验组210例,于孕晚期注射HB IG共3次;对照组116例,孕妇不接受HB IG注射。前瞻性追踪所有孕妇的新生儿外周血HBVM情况及产妇初乳中HBVM及HBV-DNA情况。结果试验组新生儿HBV宫内感染率为10.48%(22/210),对照组新生儿HBV宫内感染率为27.59%(32/116),二者比较差异有统计学意义(P=0.000 0)。HBsAg单阳性的220例孕妇中,试验组和对照组新生儿HBV宫内感染率分别为7.64%和26.32%,二者比较差异有统计学意义(P=0.000 0)。HBsAg和HBeAg均阳性的106例孕妇中,试验组和对照组新生儿HBV宫内感染率分别为22.73%和32.50%,二者比较差异无统计学意义(P>0.05)。试验组产妇初乳中HBsAg阳性率、HBeAg阳性率和HBV-DNA滴度比对照组均低,但二者分别比较差异均无统计学意义(P>0.05)。结论孕晚期HB IG被动免疫仅可降低HBsAg单阳孕妇HBV宫内传播率,而对HBsAg和HBeAg阳性孕妇并无明显阻断作用;HB IG被动免疫对HBV携带产妇初乳中HBVM及HBV-DNA无明显影响。

Objective To explore the risk of HBV maternal-infant transmission and the changes of infectious markers in colestram for chronic HBV carriers after HBIG immunoprophylaxis. Methods Information of 326 pregnant women of chronic HBV carriers and their infants has been collected in a prospective longitudinal study. 210 pregnant women who had received HIBG injection during the third trimester were rolled into experimental group, while the other pregnant women in control group did not received any intervention. HBV infectious markers were detected in colostrums of mothers and in serum of newborns. Results Being compared the intrauterine infectious rates of HBV for newborns in the experimental and control group,there was statistically difference between the two groups （ 10.48% versus 27.50% ）. As for the carriers of HBsAg positive mothers ,the intrauterine infectious rates of newborns in the two groups were 7.64% and 26.32% respectively （P 〈 0.05 ）. But for the carriers of HBsAg and HBeAg positive mothers, the intrauterine infectious rates of newborns in the two groups were 22.73% and 32.50% respectively （ P 〉 0.05）. The positive rates for HBsAg, HBeAg and HBV-DNA in colestmms were not statistically different from the two groups too. Conclusion Passive immunoprophylaxis with HIBG in the third trimester can decrease the HBV intrauterine infectious rate of HBsAg positive mothers, but there was no effect on that of HbsAg and HBeAg positive mothers. HIBG immunoprophylaxis does not change the status of HBVM and HBV-DNA in colostrum signifcantly.