不同方案阻断乙型肝炎病毒父婴垂直传播的初步研究

Different regimens for blocking paternal-infant vertical transmission of hepatitis B virus

目的:评价运用不同方案阻断乙肝病毒父婴垂直传播的效果。方法:265例乙肝表面抗体(HBsAb)阳性的孕妇被分为3组(A组:124例,B组:94例,C组:47例),287例HBsAb阴性的孕妇分成D、E组(D组:187例,E组:100例),所有孕妇丈夫的乙肝表面抗原(HBsAg),乙肝病毒e抗原(HBeAg),抗乙肝核心抗体(抗-HBc)均为阳性。对A、D组的孕妇自妊娠第28周起每月肌注200IU的乙肝免疫球蛋白(HBIG)(28、32、36W),产前共注射3次;B、E组孕妇仅做常规产检;C组妇女采用洗涤液洗涤精液后人工授精,有47例妊娠,孕28周开始每4周对孕妇肌注HBIG200IU至分娩。分娩时新生儿抽脐静脉血查乙肝病毒血清标志物(HBVM)。结果:在乙肝病毒阴性的孕妇所生的554例新生儿中,101例感染乙肝病毒,宫内感染率分别为A组12.10%,B组13.82%,C组12.77%,D组22.99%,E组24.00%。结论:主动或被动免疫致孕妇体内HBsAb可以有效地阻断乙肝病毒父婴垂直传播。

Objective To assess the efficacies of different regimens for blocking paternal-infant vertical transmission of hepatitis B virus. Methods 265 HbsAb-positive pregnant women were divided into three groups （124 in group A,94 in group B,and 47 in group C） and 287 HbsAb-negative pregnant women were assigned to two groups （187 in group D and 100 in group E）. All of their husbands were HBeAg,HbsAg,and antiHBc positive. Groups A and D received intramuscular injection of HBIG of 200IU at 28,32,and 36 weeks of pregnancy. Groups B and E received only routine prenatal examination. The women in group C who received intrauterine insemination after semen washing were administered HBV-Ig of 200 IU every 4 weeks from week 28 to delivery. HBVM was detected in the newborns. Results In 554 newborns whose mothers were HBV negative,101 were infected with HBV. The rate of intrauterine infection was 12.10% in group A,13.82% in group B,12.77% in group C,22.99% in group D,and 24.00% in group E. Conclusions The production of HBsAb in pregant women due to active or passive immunization can effectively block paternal-infant vertical transmission of hepatitis B virus.