乙肝免疫球蛋白与乙肝病毒疫苗联合应用阻断乙肝母婴传播的研究

Clinical Analysis of Hepatitis B Immunoglobulin Combined with Hepatitis B Vaccines on Interrupting Mother-to-infant Transmission of Hepatitis B

目的:评价乙肝免疫球蛋白(HBIG)联合乙型肝炎病毒疫苗(HBVac)免疫预防措施阻断乙肝病毒(HBV)母婴传播的临床效果。方法:选择2002年1月至2010年1月在本院分娩的198例HBs Ag阳性母亲及其198例新生儿为研究对象,同时依据HBIG接种方式的不同将孕妇分为研究组和对照组。研究组126例,于孕期的第28、32、36周分别肌内注射HBIG 200 U;新生儿出生后分别于出生后12小时和30天肌内注射HBIG 200 U,出生当天、第1个月和第6个月各接种5μg HBVac。对照组72例,在孕期不注射HBIG,其新生儿接种方法同研究组。结果:研究组和对照组分娩新生儿的HBV感染率分别为0.79%和2.78%,差异无统计学意义(校正χ2=0.245,P>0.05);且HBe Ag(+)母亲所生孩子比HBe Ag(-)母亲所生孩子HBV感染率有增高的趋势,但无差异无统计学意义(4.65%vs.0.65%,校正χ2=1.433,P>0.05)。结论:孕妇孕晚期使用HBIG对HBV母婴传播和新生儿对HBVac的抗体应答无明显影响,其中HBs Ag单阳性孕妇的阻断率有高于HBs Ag和HBe Ag双阳性孕妇的趋势。

Objective： To evaluate systematically the validity of injection of hepatitis B immunoglobulin（ HBIG） during the third trimester of pregnancy combined with injection of HBIG and hepatitis B vaccines for neonates on interrupting intrauterine transmission of HBV. Methods： 198 HBs Ag-gositive mothers and their 198 newbornsin born in our hospital from January 2002 to January 2010 were enrolled in the study. According to the different vaccination ways of HBIG,they were divided into study group and control group. In study group,126 patients were intramuscularly injected with HBIG of 200 U at week 28,32 and 36 of gestation; the neonates were intramuscularly injected with HBIG of 200 U at postnatal 12 h,and on the 30 th day after born and vaccinated gene Hepatitis B vaccine of 5μg at birth date,a month and six months after birth respectively. 72 pregnant women in the control group were not injected with HBIG; the neonates were intramuscularly injected with HBIG of 200 U at postnatal 12 h,and on the30 th day and vaccinated gene Hepatitis B vaccine of 5 μg at birth date,a month and six months after birth respectively. Results： The positive rate of mother-infant transmission of HBV in study group was 0. 79%,and the positive rate of control group was 2. 78%,and there was no significant difference between the two group（ Correctionχ2= 0. 245,P〈0. 05）. HBe Ag positive mother was significantly higher than HBe Ag negative mother in positive rate of HBs Ag in children（ 4. 65 % vs. 0. 65 %,Correction χ2= 1. 433,P〈0. 05）. Conclusions： HBIG administration in pregnant women during late pregnancy has no effect on preventing perinatal HBV infection and enhancing the anti-iBs response.