乙型肝炎免疫球蛋白阻断HBV垂直传播的疗效观察

Study on the preventive effect of hepatitis B immunoglobulin for the hepatitis B virus vertical transmission

目的观察评价外源性注射乙型肝炎免疫球蛋白（HBIG）对HBV母婴垂直传播的阻断效果和安全性。方法选取2006年7月-2007年7月在我院产前检查和分娩的HBsAg阳性孕妇200例作为研究对象，根据知情同意原则，分为3组。A组：同意孕期及产后注射HBIG者75例；B组：同意产后注射HBIG者85例；C组：不同意或因经济原因无法注射HBIG者40例。凡新生儿HBV DNA阳性，即表示胎儿宫内感染HBV；婴儿出生后6个月HBV DNA阳性，亦表示垂直传播HBV。结果孕28周时孕妇HBV标志物各指标检测结果3组间比较．差异无统计学意义（P〉0．05），而A组经过产前3次HBIG注射之后，HBsAg、HBeAg、抗-HBs阳性率与B组和C组间比较，差异有统计学意义（P〈0．01，P〈0．05）。3组孕妇在孕28周和产前血清中的HBVDNA阳性率间比较，差异无统计学意义（P〉0．05）；3组产后乳汁中HBV DNA阳性率间比较，差异有统计学意义（P〈0．05，P〈0．01）。新生儿和6个月婴儿HBV感染率A组〈B组〈C组（P〈0．05，P〈0．01）。结论肌注HBIG对HBV垂直传播的阻断有明显效果，并可降低母乳喂养感染的风险，且孕晚期孕妇和新生儿使用HBIG优于仅产后新生儿肌注。孕晚期孕妇肌注HBIG，可降低HBV的传染力。

Objective To observe the preventive effect of hepatitis B immunoglobulin （HBIG） for the HBV mother-infant vertical transmission.Method 200 HBsAg（ ＋ ） pregnant women were divided into three groups according to their will. Pregnant women in group A （n=75） were given HBIG since pregnancy 28 weeks and within 24 hours after parturition, besides their newborns. Pregnant women in group B （n = 85） were injected HBIG within 24 hours after parturition. Pregnant women in group C （n = 40） didn＇t take HBIG. Newborns in three groups were all taken HBV vaccine. Mather-infant vertical transmission standards： HBV DNA was positive either within 24 hours or six months after parturition. Results The positive rates of HBsAg, anti-HBs, HBeAg, anti-HBe and anti-HBc had no statistical difference in pregnancy 28 weeks mothers＇ serum（ P 〉 0.05）. After injected HBIG three times, group A had different positive rates of HBsAg, HBeAg and anti-HBs, compared with those in other two groups（ P 〈 0.05, P 〈 0.01 ）. The HBV DNA positive rates in milk had statistical difference between three groups（ P 〈 0.05, P 〈 0.01 ）. The HBV infection rates of newborns and six month infants were group A 〈 B 〈 C（ P 〈 0.05, P 〈 0.01 ）. Condusions HBIG intramuscular injection has obviously preventive effect for the HBV mother-infant vertical transmission, and may decrease the risk of infection by maternal breast-fed.