应用HBIG阻断新生儿HBV宫内感染的研究

Study on Blocking Intrauterine Infection for Pregnant Women with High Hepatitis B Viral Load

目的探讨乙肝免疫球蛋白(HBIG)对高乙肝病毒(HBV)载量孕妇宫内感染阻断。方法 2009年1月至2012年5月选择我院高HBV载量孕妇139例:HBsAg、HBeAg和(或)抗HBe和抗HBc阳性、HBV-DNA≥1.0×107拷贝/mL。随机分观察组79例和对照组60例。观察组孕妇28、32、36 w肌注HBIG200IU,对照组孕期不采取特殊措施。二组新生儿出生6 h内肌注HBIG100 IU,乙肝疫苗全程接种,采集出生及12月龄静脉血,检测HBsAg、抗HBs、HBeAg、抗HBe、抗HBc和HBV-DNA。结果新生儿HBV宫内感染率观察组10.1%(8/79)低于对照组31.7%(19/60),两组差异有统计学意义(P<0.05)。新生儿持续至12月龄,HBV慢性感染率观察组8.9%(7/79)低于对照组23.3%(14/60),两组差异有统计学意义(P<0.05);HBV阻断率观察组91.1%(72/79)高于对照组76.7%(46/60),两组差异有统计学意义(P<0.05);免疫成功率观察组77.2%(61/79)高于对照组66.7%(40/60),但两组差异无统计学意义(P>0.05)。结论高HBV载量孕妇孕末期应用HBIG可降低新生儿HBV宫内感染率及慢性感染率,提高HBV母婴传播阻断率。

Objective To investigate the effect of hepatitis B immune globulin （HBIG） on blocking intrauterine infection for the pregnant women with high hepatitis B viral （HBV） load. Methods A total of 139 cases of pregnant women with high HBV load in our hospital were selected from January 2009 to May 2012 ： HBsAg, HBeAg and （or） anti - HBe and anti - HBe positive, HBV - DNA ≥1.0×10^7 copies / mL. They were randomly divided into the observation group of 79 cases and the control group of 60 cases. Women in the observation group were injected with HBIG 200IU in 28th, 32th and 36th weeks of pregnancy. The control group did not take special measures during pregnancy. The two groups of newbo- rns were injected with HBIG 100 IU within 6 hours after birth and vaccinated with Hepatitis B. Venous blood was collected at birth and 12 -month -old for the two groups of newborns to determine HBsAg, anti -HBs, HBeAg, anti -HBe, anti - HBc and HBV - DNA. Results The HBV intrauterine infection rate of newborns in the observation group was 10. 1% （8/79）, lower than that in the control group which was 31.7% （19/60）. The difference was statistically significant （P 〈 0. 05 ） between the two sets of data. The chronic HBV infection rate of 12 - month - old infants in the observation group was 8.9 %. （7/79）, lower than that in the control group which was 23.3% （14/60）. The difference was statistically signifi- cant （P 〈 0. 05 ）. The Blocking HBV infection rate in the observation group was 91.1% （72/79）, higher than that in the control group which was 76. 7% （46/60）. The difference was statistically significant （P 〈 0. 05 ）. The immune success rate in the observation group was 77.2% （61/79） , higher than that in the control group which was 66. 7% （40/60）, but the difference was not statistically significant （P 〉 0. 05）. Conclusion The application of HBIG for pregnant women with high HBV load during late pregnancy can increase the rate of HBV intrauterine infection and chronic HBV infection for the infants and improve the blocking rate of mother - to - child HBV transmission.