联合免疫预防乙型肝炎病毒宫内感染的临床观察

Clinical observation on combination immunization in preventing intrauterine HBV infection

目的:探讨孕妇主动与被动联合免疫乙型肝炎病毒(HBV)宫内感染的作用和机理。方法:将106例HBsAg(+)孕妇分成两组,预防组60例,自孕妇20周起多次注射乙肝疫苗(HBVac)和乙肝免疫球蛋白(HBIG);对照组46例,不用HBVac和HBIG。母婴血清HBsAg、HBeAg和HBsAb用固相放免法检测,HBV-DNA用有套式PCR检测。结果:预防组新生儿血清HBsAg和HBV-DNA检出率明显低于对照组(P<0.05);预防组新生儿HBsAb阳性率显著高于对照组(P<0.05)。结论:孕妇于孕期通过HBIG和HBVac联合免疫,可有效预防HBV宫内感染,其机理可能为胎儿获得被动免疫。

Objective： To study the efficacy and possible mechanism of active and passive immunization on pregnant woman in preventing intrauterine HBV infection. Methods： 106 pregnant women with HBsAg positive were divided into two groups. In the prevention group,60 cases were injected with hepatitis B vaccine （HBVac）and hepatitis B immunoglobulin （HBIG）during pregnancy since the 20th week of gestation）.In the control group,46 cases without injection of HBV ac or HBIC. HBsAg, HBeAg and anti-HBs were tested with solid phase radio immunoassay and HBV-DNA in serum was detected with nested polymerase chain reaction in maternal and neonates. Results： The detection rate of the HBsAg and HBV-DNA in the newborns of prevention group was significantly lower than that of the control group （3.3% vs. 26.1%, 10% vs. 34.8%, P〈0.05, respectively）; the detection rate of anti-HBs was significantly higher in the newborns of the prevention group than that of the control group （33.3% vs. 8.7%, P〈0.05）. Conclusion： Immunization with HBVac and HBIC during pregnancy may prevent intrauterine HBV infection effectively and its mechanism may be that the fetuses acquire passive immunization.