不同母婴阻断方式对新生儿乙型肝炎病毒母婴传播的影响

Effects of different maternal and child block modes on mother-to-child transmission of neonatal hepatitis B virus

目的:观察不同母婴阻断方式对HBV阻断效果的影响。方法:2006年1月～2010年1月在承德医学院附属医院进行产前检查的HBV-DNA阳性的孕妇共85例,随机分为3组。其中阻断Ⅰ组30例,只应用HBIG;阻断Ⅱ组30例,孕妇自妊娠28周开始口服拉米夫定,100 mg/天,直至产后30天,新生儿出生后按与阻断Ⅰ组同样的方法注射HBIG;对照组25例,在妊娠末期不采取措施。3组新生儿出生24 h内均注射乙肝疫苗。3组新生儿在出生24 h、7月和12月不同时间分别检测血清HBV-marker和HBV-DNA。结果:阻断I组和II组24 h、7月龄和12月龄HBsAg阳性率低于对照组(P<0.05);阻断I组和II组7月龄和12月龄HbsAb阳性率高于对照组(P<0.05);3组血清HbsAb定量,阻断I组、阻断II组7月龄、12月龄均高于对照组(P<0.05)。结论:孕晚期采用注射HBIG和应用拉米夫定两种不同母婴阻断方式均能够有效阻断HBV母婴传播,降低胎儿的感染率。

Objective：To observe the effects of different maternal and child block modes on the effectiveness of hepatitis B virus（HBV） block. Methods：85 pregnant women with positive HBV-DNA who received prenatal examination in affiliated hospital of Chengde medical college from January 2006 to January 2010 were selected and divided into three groups randomly： 30 cases in block Ⅰ group were treated with HBIG;30 cases in block Ⅱ group were treated with oral administration of lamivudine from the 28th gestational weeks to 30 days after delivery,100 mg per day,the neonates were treated with HBIG;25 cases in control group didn＇t receive any treatment in the end of pregnancy.The neonates in the three groups were treated with injection of hepatitis B vaccine within 24 hours after birth.The serum HBV-marker and HBV-DNA of the neonates in the three groups were detected at 24 hours,7 months and 12 months after birth. Results：The positive rates of HBsAg in block Ⅰ group and block Ⅱ group at 24 hours,7 months and 12 months after birth were significantly lower than those in control group（P0.05）;the positive rates of HBsAb in block Ⅰ group and block Ⅱ group at 7 months and 12 months after birth were significantly higher than those in control group（P0.05）;the quantitation of HBsAb in block Ⅰ group and block Ⅱ group at 7 months and 12 months after birth were significantly higher than those in control group（P0.05）. Conclusion：The two kinds of maternal and child block modes（injection of HBIG and oral administration of lamivudine） both can block mother-to-child transmission of HBV effectively and reduce the infection rate of fetuses.