应用PCR病毒定量评价免疫预防对阻断母婴垂直传播乙型肝炎价值的研究

Study on the Blockage of Mother-Infant HBV Transmission Through Reduction of Maternal Blood HBV-DNA Content(Measured Quantitatively with PCR Technic)with Pre-and/or Intrapartal Antiviral Therapy

目的:探讨HBsAg阳性孕妇孕前、产前降低血清HBV-DNA含量水平,对阻断HBV母婴传播的意义。方法:应用荧光定量聚合酶链反应(PCR)技术。结果:检测血清乙型肝炎病毒表面抗原(HBsAg)阳性的234例孕妇及配对新生儿血清HBV-DNA含量,婴儿HBV传播率为31.2%。乳汁排毒率32.9%。根据孕妇HBV-DNA测定值高低分组,其中,孕前治疗组62例;孕前未接受治疗孕中免疫阻断组97例;对照组75例。三组比较母婴传播率,均有显著性差异(P<0.01)。且传播率依次为11.3%、29.9%及49.3%。三组间的乳汁排毒率均有显著性差异(P<0.001),排毒率依次为9.7%、29.9%及56.0%。分娩前HBV-DNA值<104cop-ies/ml的67例孕妇,其产婴儿未检测出HBV感染。结论:孕妇于孕前抗病毒治疗(有效降低HBV携带量)及孕期通过HBIG免疫,可有效预防HBV宫内感染。

Objective To study the effect of pre - and/or intrapartal reduction of maternal blood content of HBV - DNA on the blockage of mother - infant HBV transmission in HBsAg positive pregnant women. Methods This study involved 234 HBsAg positive pregnant women of three groups ： ① 62 women found to be HBsAg positive before pregnancy were treated with lamivudine until the serum HBV - DNA contents dropped to below 10^6 copies/ml. They were allowed to be pregnant and furthur treated with HBIg from 28 week gestation on. ② 97 women were found to be HBsAg positive only after pregnancy and were treated intrapartally only with HBIg from 28 week gestation on. ③ 75 women were found to be HBsAg positive just before labor and received on anti - viral therapy. Serum HBV - DNA contents were measured quantitatively with PCR technic in these women just before delivery. The milk specimens on d2 - 5 post - patum and the neonates＇ serum specimens were examined for HBV - DNA quantitatively. Results As a whole, the positive rate of HBV - DNA in the neonates was 31.2% （73/234） and the positive milk rate was 32.9% （77/234）. In the 62 women with pre - and intrapartal treatment, only 7 neonates were positive （ 11.3% ） and the milk positive rate was only 9.7% （6/62）. The corresponding figures for the other two groups were： 29 （29.9%）, 29.9% （29/97） and 37 （49.3%）, 56.0% （42/75） respectively. Differences between the respective figures were all significant （ P 〈 0.01 ）. The most significant finding was that in the 67 pregnant women with post -treatment HBV -DNA contents below 10^4 copies/ml, none of the neonates were positive for HBV infection. Conclusion Pre - and/or intrapaxtal anti - viral treatment in pregnant women can substantially reduce intrauterine HBV infection of fetus thus block the mother- infant HBV transmission.