孕晚期注射乙型肝炎免疫球蛋白阻断乙型肝炎病毒母婴传播的临床观察

Prevention of Hepatitis B Virus Vertical Transmission Using Hepatitis B Immunoglobulin in the Third Trimester of Pregnancy

目的:探讨HBsAg阳性和HBeAg阳性携带孕妇孕晚期应用乙型肝炎免疫球蛋白(HBIG)阻断乙型肝炎病毒(HBV)母婴传播的效果。方法:将孕妇分为双阳性组(A组)和单阳性组(B组)[HBsAg(+)及HBeAg(+)称为"双阳性"(A组),HBsAg(+)及HBeAg(-)称为"单阳性"(B组)];新生儿分为HBIG组和非HBIG组(对照组);HBIG组孕妇孕28、32、36周各注射HBIG200IU(共3次,部分仅注射1～2次),非HBIG组仅常规产检及监护;对两组新生儿0、6个月的静脉血作乙型肝炎两对半检测。结果:①A组孕妇的外周血HBV-DNA阳性率(76.92%)显著高于B组孕妇(8.55%),P<0.01;②A组孕妇所生HBIG组新生儿出生24h的HBsAg阳性率(10.64%)显著低于非HBIG组(33.33%),P<0.05;③A组孕妇所生HBIG组6月龄新生儿HBsAb阳转率(78.72%)明显高于非HBIG组(38.39%),P<0.01;B组孕妇所生HBIG组6月龄新生儿HBsAb阳转率(80.65%)高于非HBIG组(64.41%),P<0.05。结论:双阳性孕妇孕晚期应用HBIG可有效降低乙型肝炎宫内感染率;无论是双阳性还是单阳性孕妇,孕晚期应用HBIG可提高6月龄新生儿HBsAb阳转率。

Objective： To explore the efficacy of hepatitis B immunoglobulin （HBIG） used during the third trimester of pregnancy to prevent vertical transmission of HBV. Methods： A cohort of HbsAg-positive mothers with or without positive HBeAg were assigned to Group A （HBsAg positive and HBeAg-positive, or ＂dual positive＂） and Group B （HBsAg positive and HBeAg-negative, or ＂single positive＂）, while their newborns were assigned to the HBIG Group and Non-HBIG Group according to their mothers＇ use of HBIG. At the 28th, 32th, and 36th weeks of pregnancy, mothers of the HBIG group received 200 IU of HBIG Group （three shots required, but not completed in some during the pregnancy）. Venous blood of all infants was collected for test of serological HBV markers during their Ist day and 6th month of age. Results： ①Significantly, more women in the Group A were found to have positive HBV-DNA （76.92%）, compared with those in Group B （8.55%）, P〈0.01; ②Of mothers in Group A, infants assigned to HBIG group showed significantly Rower rate of positive HBsAg （10.64%） at 24 hours after birth, compared with those assigned to the non- HBIG group （33.33%）, P〈0.01;③Six months later, HBIG-treated infants of Group A （Group B） mothers showed a 78.72% （80.65%） rate of HBsAb seroconversion, compared with 38.39% （64.41%） among non-HBIG-treated infants, P〈 0.05. Conclusion： Administration of HBIG in the third trimester of pregnancy appeared effective in protecting newborns of HBeAg-positive HBV carried from intrauterine HBV infection. For infants of both HBeAg-positive or negative mothers, HbsAb seroconversion at 6 months of age can be raised with late pregnancy use of HBIG.