不同方案乙肝免疫球蛋白阻断血清乙肝病毒表面抗原、乙肝病毒阳性孕妇宫内传播的研究

Contrast Study on Effect of Hepatitis B Immunity Globulin with Different Injection Methods to Interrupt Intrauterine Transmission from Mothers with Positive HBsAg and HBV-DNA Serum to Infants

目的:探讨采用不同方案孕期使用乙肝免疫球蛋白(HBIG)阻断乙肝病毒宫内传播的效果,以便选择有效且经济的阻断方案。方法:选择血清乙肝病毒表面抗原(HBsAg),乙肝病毒(HBV-DNA)阳性孕妇132例,随机分为A组27例于孕20,24,28,32,36,38周分别肌肉注射HBIG 200 U;B组38例于孕28,32,36周分别肌肉注射HBIG 400 U;C组45例于孕28,32,36周分别肌肉注射HBIG 200 U;对照组22例孕期不进行干预。所有132例新生儿进行HBIG和HBVac的联合免疫。观察7月龄时,婴儿的血清HBV-M和HBV-DNA,比较各组宫内感染率。结果:A组2例发生宫内感染,宫内感染率7.4%;B组3例发生宫内感染,宫内感染率7.9%;C组5例发生宫内感染,宫内感染率11.1%。对照组8例发生宫内感染,宫内感染率36.4%。A,B,C 3组宫内感染率分别与对照组比较,差异有统计学意义(P<0.05);3组间两两比较,差异无统计学意义。结论:孕期使用HBIG阻断HBV宫内感染安全有效,在血清HBsAg,HBV-DNA阳性孕妇群中,选择孕晚期每月注射200 IU可达到与同等剂量分6次注射和高剂量分3次注射相同的效果。从而推断,低剂量分3次注射有效且最经济。

Objective：To study the effect of Hepatitis B immunityglobulin（HBIG） with different injection methods to interrupt inner-uterus transmission from mothers with positive epatitis B surface antigen（HBsAg） and Hepatitis B Virus-DNA（HBV-DNA） serum to infants for the selection of the most effective and cheapest project.Method：One hundred and thirty-two pregnant women with positive HBsAg and HBV-DNA serum were randomly divided into four groups.200 U HBIG was intramuscularly injected to 27 women of group A at 20,24,28,32,36,38 gestational weeks.400 U HBIG was intramuscularly injected to 38 women of group B at 28,32,36 gestational weeks.200 U HBIG was intramusculaly rinjected to 45 women of group C at 28,32,36 gestational weeks.There was no intervention in 22 women of control group.HBIG and HBVac were used to all the 132 newborns.Serum HBV-M and HBV-DNA of those infants were tested at 7 month of birth.Result：Intrauterine transmission rate of group A,B,C and control group was 7.4%,7.9%,11.1%,36.4%,separately.A significant difference was found between group A and control group,group B and control group,group C and control group（P0.05）.No significant difference was found among the interventional groups.Conclusion：It is effective and safe to use HBIG during pregnant.We can concluded that the method with 200 U injection 3 times can achieve the same effect with the other two methods（400 U 3 times,200 U 6 times）.Obviously,it can be the cheapest project.