乙型肝炎免疫球蛋白阻断HBV宫内感染的临床研究

CLINICAL STUDY ON THE BLOCKING EFFECT OF HEPATITIS B IMMUNOGLOBULIN ON HBV INTRAUTERINE INFECTION

目的 :研究乙型肝炎免疫球蛋白 (HBIg)阻断HBsAg阳性孕妇HBV宫内感染的疗效并探讨其适应症。 方法 :86例HBsAg阳性孕妇随机分为治疗组 (n =40 )和对照组 (n =46) ,均在妊娠 2 8周时抽取静脉血检测HBsAg、HBeAg和HBVD NA。治疗组自 2 8周开始每 4周肌注一次HBIg(2 0 0IU)直至分娩。对照组不给予上述药物。新生儿出生后即取静脉血检测HBsAg。结果 :治疗组新生儿HBsAg阳性率明显低于对照组。HBeAg阳性和阴性孕妇均可发生宫内感染 ,但HBeAg阳性孕妇所生新生儿HBsAg阳性率明显高于HBeAg阴性者。而两组中HBVDNA阴性孕妇均未发生宫内感染。 结论 :HBIg能有效降低HBsAg阳性孕妇的宫内感染发生率 ,HBVDNA检测可以作为是否应用HBIg的指针。

Objective:To evaluate blocking effect of hepatitis B immunoglobulin (HBIg) on hepatitis B virus (HBV) intrauterine infection in HBsAg positive pregnant women and explore its indication.Methods:Eighty-six HBsAg positive pregnant women were divided into treatment group(n=40) and control group(n=46) at random. Serum HBsAg、HBeAg and HBVDNA were determined in all women at 28 weeks.Only the women in treatment group were pretreated with HBIg (200IU) intramuscularly every 4 weeks starting from 28 weeks of pregnancy until delivery. Serum HBsAg were detected in the newborns within 24h after the birth.Results:The HBsAg positive rate(2.5%) of newborn in treatment group were significantly lower than that(21.5%) in control group(P<0.05).HBsAg positive women might occur HBV intrauterine infection despite of either HBeAg positive or negative, but the incidence of HBV intrauterine infection in newborns born to HBeAg positive women was obviously higher than that in those borm to HBeAg negative women. In contrast, none of HBVDNA negative women in two groups occur HBV intrauterine infection.Conclusion:HBV intrauterine infection may be blocked effectively by injecting HBIg during pregnancy. The detection of serum HBVDNA in HBsAg positive pregnant women may be used as an important screening means for HBIg injection.