阻断乙型肝炎e抗原阳性母亲宫内传播的研究

A contrast study on interrupting vertical transmission of Hepatitis B virus from mother with positive e antigen to the infant

目的探讨不同剂量乙肝免疫球蛋白对乙肝表面抗原和乙肝e抗原双阳性孕妇乙型肝炎病毒宫内传播的影响。方法乙肝表面抗原和乙肝e抗原双阳性孕妇为病例组，乙肝表面抗原阳性但乙肝e抗原阴性的孕妇为对照组，对病例组和对照组均采用3种不同的干预方式：乙肝免疫球蛋白400U、乙肝免疫球蛋白200U、no-乙肝免疫球蛋白进行干预，观察各组新生儿乙肝表面抗原、乙肝表面抗体、乙肝e抗原、乙肝e抗体、乙肝核心抗体检测情况。采用定性酶联免疫法检测。结果观察病例乙肝免疫球蛋白400U组新生儿21例，乙肝表面抗原和乙肝e抗原检测均为阴性，未发现宫内感染者，追踪并复查仍未发现乙肝病毒抗原阳性者；观察病例乙肝免疫球蛋白200u组新生儿22例，乙肝表面抗原均为阴性，1例乙肝e抗原阳性，宫内感染率为4．5％；病例no-乙肝免疫球蛋白组观察新生儿20例，检测乙肝表面抗原均为阴性，5例乙肝e抗原阳性，宫内感染率为25．0％；乙肝免疫球蛋白200U组宫内感染率低于no-乙肝免疫球蛋白组，但无显著性差异（Χ^2=3．58，P=0．058）。结论孕晚期注射乙肝免疫球蛋白400U和200u对阻断乙型肝炎e抗原阳性母亲宫内传播均有效果，乙肝免疫球蛋白400U干预方案效果更好。

Objective To study effect of different doses of hepatitis B immunoglobulin （HBIG） on interrupting vertical transmission of hepatitis B virus （HBV） from pregnant woman with both positive HBV surface antigen （HBsAg） and e antigen （HBeAg） to the fetus. Methods 63 pregnant women with both positive HBsAg and positive HBeAg were included in the study group and 485 pregnant women with only positive HBsAg but negative HBeAg were included in the control group. All pregnant women in the two groups were given either 400U of HBIG （HBIG 400 study group： n =21, HBIG 400 control group： n =95）, or 200U of HBIG （HBIG 200 study group： n =22, HBIG 200 control group： n = 198） or OU of HBIG（NO-HBIG study group： n =20, NO-HBIG control group： n = 192） three times （each time at respective 28, 32 and 36 weeks of gestation） respectively. The qualitative detection of 5 items of HBV including HBsAg, HBsAb, HBeAg, HBeAb and HBcAb of neonates within 24 hours after birth in the two groups were conducted. The quantitative detection of HB 5 items was conducted by using ELISA. The results of neonates in the two groups were compared. Results In the HBIG 400 study group, 21 neonates all had negative HBsAg and HBeAg and the negative results maintained up to the follow-up and re-examination, suggesting no intrauterine transmission of HBV from mother to the child occurred. In the HBIG 200 study group, 22 neonates all had negative HBsAg and only 1 neonate had positive HBeAg, the HBV intrauterine infection rate was 4.5%. In the NO-HBIG study group, all 20 neonates had negative HbsAg and 5 neonates had positive HBeAg, the HBV intrauterine infection rate was 25.0%. The HBV intrauterine infection rate in the HBIG 200 study group was lower than that in the NO-HBIG study group, but there was not significant difference between the two groups （Χ^2 = 3.58, P = 0. 058 ）. Conclusion Intramuscular injection of 400U HBIG and 200U HBIG in late pregnancy for 3 times are both effective for interrupting HBV intrauterine transmission from mother with positive HBeAg to the fetus. But the effect of intramuscular injection of 400U HBIG for 3 times is more significant.