2种方案阻断乙型肝炎病毒母婴传播效果比较

Comparison of the effect of two treatment schemes in preventing of mother-to-child transmission of hepatitis B virus

目的探讨2种方案对阻断乙型肝炎病毒母婴垂直传播的免疫效果。方法选取1998年3月至2002年3月在新乡市疾病预防控制中心门诊部就诊的乙型肝炎病毒携带孕妇389例,按照孕妇意愿分为三联治疗组和对照组,三联治疗组279例采用三联疗法进行干预,即给予乙型肝炎免疫球蛋白(HBIG)、乙型肝炎疫苗、左旋咪唑涂布剂联合应用;对照组110例未进行干预治疗。选取2008年5月至2012年7月在新乡市疾病预防控制中心门诊部就诊的乙型肝炎病毒携带孕妇271例作为HBIG组,采取HBIG接种法对孕妇进行干预。比较3组孕妇产后阻断乙型肝炎母婴垂直传播的效果。结果对照组孕妇110例中新生儿脐带血HBsAg阳性16例(14.55%),其中HBeAg阳性孕妇68例,其新生儿脐带血HBsAg阳性12例(17.65%);HBeAg阴性孕妇42例,其新生儿脐带血HBsAg阳性4例(9.52%)。三联治疗组孕妇279例中新生儿脐带血HBsAg阳性7例(2.50%),其中HBeAg阳性孕妇140例,其新生儿脐带血HBsAg阳性4例(2.86%);HBeAg阴性孕妇139例,其新生儿脐带血HBsAg阳性3例(2.16%)。HBIG组271例中新生儿脐带血HBsAg阳性7例(2.58%),其中HBeAg阳性孕妇137例,其新生儿脐带血HBsAg阳性4例(2.92%);HBeAg阴性孕妇134例,其新生儿脐带血HBsAg阳性3例(2.24%)。三联治疗组与HBIG组出生的新生儿HBsAg阳性率比较差异无统计学意义(χ2=0.003,P=1.00);三联治疗组和HBIG组与对照组比较差异均有统计学意义(χ2=18.555,P<0.01;χ2=17.809,P<0.01)。结论三联疗法和HBIG接种法对阻断乙型肝炎病毒母婴垂直传播均有较好效果,且效果相当,故主张应用简单方便的HBIG接种法。

Objective To explore the effect of two treatment schemes in preventing of mother-to-child transmission of hepatitis B virus. Methods Three hundred and eighty-nine pregnants who carried hepatitis B virus and visit in outpatient department of Xinxiang City Center for Disease Control and Prevention from May 1998 to March 2002 were selected as the sample. The patients were divided into triple therapy group[hepatitis B immune globulin（ HBIG）,hepatitis B vaccine,levamisole coating agent in combination]（n = 279）and control group（without treatment）（n = 110） by patients willing. Two hundred and seventy-one pregnants who carried hepatitis B virus and visit in outpatient department of Xinxiang City Center for Disease Control and Prevention from May 2008 to July 2012 were selected as HBIG group. The treatment effect was compared among the three groups. Results In control group,including of six-eighty HBeAg-positive pregnant women,twelve neonates（17. 65%） of them with newborn cord blood HBsAg positive;forty-two HBeAg-negative pregnant women,four neonates（9. 52%）of them with neonatal cord blood HBsAg positive. In the triple therapy group,including one hundred and forty-two HBeAg-positive pregnant women,four neonates（2. 86%） of them with newborn cord blood HBsAg positive;one hundred and thirty-nine HBeAg-negative pregnant women,three neonates（2. 16%） of them with neonatal cord blood HBsAg positive. In HBIG group,including of one hundred and thirty-seven HBeAg-positive pregnant women,four neonates（2. 92%） of them with newborn cord blood HBsAg;one hundred and thirty-four HBeAg-negative pregnant women,three neonates（2. 24%） of them with newborn cord blood HBsAg positive. There was no statistic difference of HBsAg positive rate between the triple therapy group and HBIG group（ χ^2=0. 003,P = 1. 00）;there were statistic difference of HBsAg positive rates between triple therapy group,HBIG group and control group（χ^2= 18. 555,P〈0. 01;χ^2= 17. 809,P〈0. 01）. Conclusion Both triple therapy and HBIG method have a good effect in preventing the mother-to-child vertical transmission of hepatitis B virus,and the two method have a similar effect. So the simple and convenient HBIG inoculation method is recommended.