乙肝免疫球蛋白联合乙肝疫苗阻断HBV母婴传播的相关性研究

Correlative study on blocking effect of hepatitis B immunoglobulin combined with hepatitis B vaccine on mother-infant transmission of hepatitis B virus

目的:探讨乙肝免疫球蛋白(HBIG)联合乙肝疫苗阻断乙肝病毒(HBV)母婴传播失败原因。方法:选择HBsAg阳性、HBeAg阳性、HBV-DNA阳性孕妇218例,检测孕妇分娩前HBVDNA,新生儿(出生24h内且未进行阻断前)、7月龄及1岁时婴儿的HBsAg、抗HBs;所有新生儿出生后24h内在三角肌注射HBIG200IU,同时在大腿前部外侧肌内注射基因工程乙肝疫苗10μg,2周再注射同等剂量的HBIG,1、6月时分别注射同等剂量的乙肝疫苗。结果:孕妇分娩前血清HBVDNA含量>1×106copies/ml组7月龄、1岁时HBsAg阳性率分别为18.12%、19.38%,HBVDNA含量<1×106copies/mi组为7.50%、7.25%(P<0.05)。注射HBIG及乙肝疫苗后,宫内感染组7月龄、1岁时HBsAg阳性率分别为75.00%、74.19%,非宫内感染组为3.76%、4.19%(P<0.01)。结论:宫内感染及孕妇分娩前血清HBVDNA含量高是HBV母婴阻断失败的主要原因。采取综合措施可提高母婴阻断效果。

Objective：To explore the failure causes of mother-infant transmission of hepatitis B virus（HBV）blocked by hepatitis B immunoglobulin（HBIG）combined with hepatitis B vaccine.Methods：218 pregnant women with positive HBsAg,HBeAg and HBV-DNA were selected;the content of HBV-DNA in pregnant women before delivery,the contents of HBsAg and anti-HBs in neonates at 24 hours after birth before blocking,infants aged 7 months and one year were detected;all the neonates were injected with 200 IU HBIG into deltoid muscle and 10 μg recombinant hepatitis B vaccine into lateral muscles of anterior thighs at 24 hours after birth,200 IU HBIG were injected after two weeks,10 μg recombinant hepatitis B vaccine were injected at one and six months.Results：The positive rates of HBsAg in neonates at 7 months and one year who were born by the pregnant women with serum HBV-DNA1×106 copies/ml before delivery were 18.12% and 19.38%,respectively;while the positive rates of HBsAg in neonates at 7 months and one year who were born by the pregnant women with serum HBV-DNA1×106 copies/ml before delivery were 7.50% and 7.25%,respectively,there was significant difference between the two groups（P0.05）.After injection with HBIG and hepatitis B vaccine,the positive rates of HBsAg in intrauterine infection group at 7 months and one year were 75.00% and 74.19%,respectively;the positive rates of HBsAg in non-intrauterine infection group at 7 months and one year were 3.76% and 4.19%,respectively,there was significant difference between the two groups（P0.01）.Conclusion：Intrauterine infection and high content of serum HBV-DNA in pregnant women before delivery are the main failure causes of mother-infant transmission of HBV,comprehensive measures should be taken to improve the blocking effect.