母体注射乙型肝炎免疫球蛋白对乙型肝炎病毒宫内感染的影响及新生儿血清乙型肝炎病毒标志物的动态变化分析

Effect of maternal injection of hepatitis B immunoglobulin on intrauterine infection of hepatitis B virus and analysis on dynamic changes of serum hepatitis B virus markers in neonates

目的研究母体注射乙型肝炎(乙肝)免疫球蛋白对乙肝病毒(HBV)宫内感染的影响及新生儿血清HBV标志物动态变化的分析。方法选取2014年6月-2015年2月该院收治的乙肝表面抗原及乙肝e抗原均阳性孕妇120例,按照孕妇是否愿意接受注射乙肝免疫球蛋白分成观察组62例及对照组58例。观察组单阳性(HBs Ag阳性)孕妇32例,双阳性(HBs Ag及HBe Ag阳性)孕妇30例;对照组中单阳性(HBs Ag阳性)29例,双阳性(HBs Ag及HBe Ag阳性)孕妇29例,4组分别记为Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组。Ⅰ组、Ⅱ组在妊娠第28周起,每周肌注乙肝免疫球蛋白400 U,直至生育新生儿。Ⅲ组、Ⅳ组则给予常规管理。结果 120例孕妇共生育134例新生儿,4组宫内感染率分别为2.63%、18.75%、21.21%、38.71%,相应地检测4组新生儿血清抗HBs产生情况,发现Ⅳ组与其他组比较,差异均具有统计学意义(χ~2=18.939 4,P<0.05)。在新生儿第1年的不断检测下,Ⅰ组发生慢性HBV感染的比例为0.00%,而Ⅱ组、Ⅲ组、Ⅳ组逐渐升高,差异有统计学意义(χ~2=16.813 6,P<0.05)。结论母体注射乙肝免疫球蛋白可有效降低HBV宫内感染概率,新生儿的HBs Ab阳性表达也明显提高,有助于HBV的防治。

Objective To study the effect of maternal injection of hepatitis B immunoglobulin（ HBIG） on intrauterine infection of hepatitis B virus（ HBV）,analyze the dynamic changes of serum hepatitis B virus markers in neonates. Methods A total of 120 pregnant women treated in the hospital from June 2014 to February 2015 were selected as research objects,whose hepatitis B surface antigen and hepatitis B antigen were positive,and the pregnant women were divided into observation group（ 62 patients） and control group（ 58 patients） according to receiving HBIG injection or not. The numbers of single positive（ HBs Ag positive） and double-positive（ HBs Ag and HBe Ag positive） pregnant women in observation group were 32 cases and 30 cases,respectively. The numbers of single positive（ HBs Ag positive） and double-positive（ HBs Ag and HBe Ag positive） pregnant women in control group were 29 cases and 29 cases,respectively; and these four groups were recorded as group Ⅰ,group Ⅱ,group Ⅲ,and group Ⅳ. The cases in group Ⅰ and group Ⅱ received intramuscular injection of HBIG（ 400 U） per week after the twenty-eighth gestational week until the birth of newborn infants,and the cases in group Ⅲ and groupⅣ were given routine management. Results A total of 134 neonates were born by 120 pregnant women,and the incidence rates of intrauterine infection in the four groups were 2. 63%,18. 75%,21. 21%,and 38. 71%,respectively. The levels of serum anti-HBs production in the four groups were detected,there were statistically significant differences between group Ⅳ and the other three groups（ χ^2= 18. 939 4,P〈0. 05）. In the course of continuous detection during the first year after birth,the proportion of chronic HBV infection in group Ⅰ was0. 00%,the proportions in group Ⅱ,group Ⅲ,and group Ⅳ gradually increased,there was statistically significant difference（ χ^2=16. 813 6,P〈0. 05）. Conclusion Maternal injection of HBIG can effectively reduce the probability of HBV intrauterine infection. The positive expression of HBs Ab in neonates is also obviously improved,which is helpful for prevention and treatment of HBV.