强化免疫阻断乙肝病毒母婴传播的应用研究

Application Study on the Interruption of HBV Maternal-infantile Intrauterine Infection With the Strengthening Immunity

目的:探索HBV母婴阻断的有效方法,降低HBV母婴垂直感染率;评估HBV母婴强化免疫的临床价值;观察HBV母婴强化免疫的不良反应及安全性。方法:178例孕妇按病毒指标不同,分双阳组106例(HBsAg阳性,HBV DNA阳性)和单阳组72例(HBsAg阳性,HBV DNA阴性),每组随机各设观察组和对照组。观察组(A组):采用强化免疫阻断法。母体阻断:被动免疫,孕妇于妊娠20周开始注射乙肝病毒免疫球蛋白(HBIG)200IU,共5次。新生儿采用主、被动联合免疫阻断,主动免疫:重组乙肝疫苗1、2、12月龄各10μg三角肌注射;被动免疫:HBIG200 IU,出生后立即三角肌注射。对照组(B组)采用标准免疫阻断法。观察时间12个月。结果:106例双阳性孕妇应用HBIG免疫前后HBV DNA分别为6.72±1.33、5.16±1.07log10/ml(P<0.05)和6.37±1.58、5.92±0.92 log10/ml(P>0.05),双阳、单阳孕妇A、B两组新生儿宫内感染分别为28.6%、48.0%(P<0.05)和8.1%、14.3%(P>0.05),慢性感染分别为5.4%、18.0%(P<0.05),和5.4%、8.6%(P>0.05),免疫失败分别为3.6%、16.0%(P<0.05)和2.7%、5.7%(P>0.05),免疫成功分别为96.4%、84.0%(P<0.05)和97.3%和94.3%(P>0.05)。不良反应:178例HBsAg阳性孕妇,及其所分娩的新生儿均未出现明显的不良反应和影响母婴健康发育的不良事件。结论:HBV双阳性孕妇,妊娠中晚期进行HBIG注射和新生儿进行双重阻断的强化免疫,对减少胎儿宫内感染率,降低婴儿慢性感染率和免疫失败率均有重要意义。HBV单阳性的孕妇常规免疫即可获得较理想母婴阻断效果,无需强化免疫干预。

Objective：To investigate the effect method at the interrupion of HBV maternal-infantile intrauterine infection,lower the perpendicular infection rate of fansle baby of HBV,Evaluate the clinic value at the interruption of HBV maternal-infantile intruterine infection of HBV by the strengthening immunit Observe the aftereffect and safeties that the strengthening innunity applys the female baby of HBV interruption.Methods：Pregnancy women were divided into two groups with HBsAg and HBV DNA positive or not.Each group were divided into group A and B.A group adopted the method of the stengthening immunity.Maternal stop ：passive immunity,the pregnant woman injects hepatits B immunoglobulin（HBIG）200Iu/Min5 months of gestation,total 5times,the infant was adopted by the consociation immunity method,Active immunity：hepatitis B vaccine（HBVac）was inject,passive immunity：50 IU of HBIG,after the birth immediately the muscle injection.B group：it was adopted the standard interruption of immunity method.observe time 12 months.Results：106 cases pregnant women applys HBIG immunity in front and back the HBV DNA distinguishes to 6.72±1.33,5.16±1.07log10/ml（P〈0.05）and6.37±1.58,5.97±0.92log10/ml（P〉0.05）.Double,single positive group A,B infant intrauterine infection rate distinguish to 28.6%,48.0%（P〈0.05）and 8.1%,14.3%（P〉0.05）.chronic infection distinguishes to 5.4%,18.0%（P〈0.05）and5.4%,8,6%（P〉0.05）.immunity failure distinguishes to 3.6%,16.0%（P〈0.05）and 2.7%,5,7%（P〉0.05）.successfully immunity distinguishes to 96.4%,84.0%（P〈0.05）and97.3%,94.3%（P〉0.05）.The side-effects：The infant whom 178 pregnant woman with HBs Ag positive did not appear the obviously the Side-effects and bad affect affairs of the pregnancy woman and infant health.Conclusion：Pregnant woman of HBsAg and HBV DNA positive who injected HBIG at the middle-later period,and the infants apply HBVac of the strengthing immunity,it turns obviously down the intrauterine infection rate,the chronic infection rate and the immunity failure rates.The single HBV positive pregnant woman whose normal regulations immunity can be acquired immediately,the interruption of HBV maternal-infantile intrauterine infection,did not need to enhance the immunity intervention.