乙肝母婴联合免疫与常规免疫效果的比较

Comparison of effect of mother-child joint immunity with conventional immunity for HB

目的探讨乙型肝炎病毒感染孕妇其母婴联合免疫与婴儿单纯免疫两种方法的免疫效果。方法对112例乙型肝炎病毒标志物阳性孕妇于妊娠后期3个月（即妊娠28周后）给予乙型肝炎免疫球蛋白200U免疫阻断母婴传播作为治疗组，73例乙型肝炎病毒标志物阳性孕妇生产前不做任何免疫治疗作为对照组，两组新生儿均常规接受乙肝疫苗接种和乙型肝炎免疫球蛋白注射，12月龄时采集外周血检测乙型肝炎病毒标志物、乙型肝炎病毒DNA及肝功能。结果治疗组和对照组新生儿12个月龄时抗-HBs阳性率分别为95．5％和82．4％，两组间比较具有统计学意义（X24．09，P〈0．05）；治疗组孕妇HBVDNA高滴度者明显高于低滴度者所娩新生儿的感染率（X2=6．88，P〈0．05）；剖宫产与自然分娩之间感染HBsAg比较无显著性差异（X2=1．98，P〉0．05）。结论对乙型肝炎病毒感染孕妇采用乙型肝炎免疫球蛋白进行免疫阻断可降低宫内感染及母婴传播的发生率，提高新生儿免疫保护率，减少慢性乙型肝炎病毒感染。

Objective To investigate effects of combined immunization of pregnant women and infants and infant single immunization to prevent intrauterine transmission of HBV. Methods 112 pregnant women with positive HBV markers were given 200U of HB immunoglubulin （HBIG） for preventing mother-child transmission of HBV in the third trimester of pregnancy （that is, after 28 weeks of gestation） and were enrolled in treatment group and 73 pregnant women with positive HBV markers were not given any HBIG at antepartum and enrolled in control group. All neonates in the two groups were routinely vaccinated HBV vaccine and were injected HBIG, and their HBV markers and HBV-DNA were detected, their live function was examined at full 12 months of age. Results The positive rates of HBsAb in the two groups were 95.5 % （107/112） and 82.4% （61/74） respectively and there was a significant difference between the two groups （X2 = 4.09 ,P 〈 0.05 ）. In positive infection rate of HBV, there was no significant difference between natural vaginal delivery group and cesarean section group（X2 = 1.98, P 〉 0.05 ）. Conclusion Immunological intervention with HBIG for HBV infected pregnant women can decrease incidence of intrauterine transmission and mother-child transmission of HBV, thereby could decrease rate of chronic HBV infection.