HBsAg阳性孕妇的婴儿阻断有效后继续随访和治疗的研究

A study of continuing follow-up and therapy on infants of HBsAg positive pregnant women after effective interruption.

目的探讨HBsAg阳性孕妇的婴儿阻断有效后继续随访和治疗的必要性和临床意义。方法2001-01—2004-01对南京第二医院HBsAg阳性孕妇及婴儿实施联合免疫,婴儿于12月龄抽血检测乙肝病毒标志物(HBVm)、HBV-DNA和肝功能。将获阻断有效的4种HBVm模式(抗HBs<100mIU/mL,抗HBs、抗HBc两项阳性,抗HBs、抗HBe、抗HBc三项阳性,HBsAg或HBeAg低滴度)的婴儿分为A、B1、C1、D1四组,后三组设B2、C2、D2对照组,对A、B1、C1组婴儿再予乙肝疫苗(HBVac)20μg接种3次,D1组予同剂量HBVac治疗12次,对照组不作任何治疗。24月龄时随访HBVm、HBV-DNA和肝功能。结果治疗有效率A组为100%(24/24),B1组57.1%(20/35),C1组66.7%(10/15),D1组70.0%(7/10)。B1、C1、D1组婴儿治疗后抗HBs平均滴度分别为(745.34±238.81)、(691.65±153.76)、(602.56±212.83)mIU/mL,明显高于对照组,P<0.05。B1、C1、D1组婴儿治疗前后HBV-DNA阳性率和丙氨酸氨基转移酶(ALT)差异无显著性,P>0.05。结论获阻断有效的婴儿有必要继续随访,多次予HBVac免疫治疗可以提高抗HBs滴度,清除乙肝病毒的低水平感染。

Objective To explore the necessity and elinical significance of continuing follow-up and therapy on infants of HBsAg positive pregnant women after effective interruption. Methods All HBsAg positive pregnant women and their infants received combining immune therapy and all infants were detected HBVm, HBV-DNA and hepatic function in 12 months of age. Those infants who get the 4 modes of effective interruption （ anti-HBs 〈 100mIU/ml,anti-HBs and anti- HBc positive,anti-HBs and anti-HBe and anti-HBc positive,low level of HBsAg and HBeAg） were divided into A, B,C and D group. The study groups（ A,B1 ,C1 and D1 ） received reinoculation HBVac 20ug for 3 times and D1 group for 12 times while the control groups did not receive any treatment but were only to be detected the 3 marker mentioned above one year later together with the study groups. Results The rate of therapeutics utility of A, B1, C1, D1 group was 100% （24/24） ,57.14% （20/35 ） ,66. 67% （ 10/15 ） ,70% （7/10） respectively. The average tire of anti-HBs of B1, C1 and D1 group was （745. 34 ± 238.81 ）. （691.65 ± 153.76 ）. （602. 56 ± 212. 83 ） mIU/mL, which was higher than that of the control group, P 〈 0.05. But the positive rate of HBV-DNA and ALT of infants had no significant difference in the pretreatment and post treatment. Conclusion It is necessary that the infants of effective interruption be followed up and receive treatment of multiple HBVac so as to increase the tire of anti-HBs and clean low level virus.