拉米夫定和乙型肝炎疫苗及免疫球蛋白三者联合阻断乙型肝炎母婴传播的临床研究

Clinical Study of Combined Application of Lamivudine,Hepatitis B Vaccine and Immunoglobulin in Blocking Mother-to-child Transmission of Hepatitis B

目的探讨拉米夫定、乙型肝炎疫苗、免疫球蛋白三者联合阻断乙型肝炎母婴传播的临床效果。方法选取2012年1月—2016年1月松阳县人民医院妊娠合并乙型肝炎的患者共60例,根据治疗方法分为拉米夫定、乙型肝炎疫苗、免疫球蛋白的三联组和乙型肝炎疫苗、免疫球蛋白的二联组,比较两组患者分娩前后的乙型肝炎病毒(HBV)-DNA水平、两组婴儿的一般资料及分娩后12个月的HBV-DNA、乙型肝炎表面抗体(HBsAb)及乙型肝炎表面抗原(HBsAg)阳性率。结果分娩前三联组的丙氨酸氨基转移酶(ALT)和HBV-DNA载量低于治疗前,且低于二联组,差异有统计学意义(P<0.05),三联组的阻断率高于二联组,差异有统计学意义(P<0.05)。三联组和二联组的身长、头围、体质量、新生儿Apgar评分和出现新生儿窒息的比例比较,差异均无统计学意义(P>0.05)。结论拉米夫定、乙型肝炎疫苗、免疫球蛋白三者联合可显著提高乙型肝炎母婴传播的阻断效果,安全性良好,效果优于联合应用乙型肝炎疫苗和免疫球蛋白。

Objective To investigate the clinical effects of combined application of lamivudine,hepatitis B vaccine and immunoglobulin in preventing mother-to-child transmission of hepatitis B. Methods A total of 60 patients with hepatitis B were enrolled in Songyang People 's Hospital from January 2012 to January 2016. According to the treatment,the patients were divided into two groups, thelamivudine, hepatitis B vaccine and immunoglobulin( triple group) or hepatitis B vaccine and immunoglobulin( double group). The HBV DNA levels,the general information of two groups of infants and 12 months after delivery of HBV DNA,anti-HBs and HBsAg positive rate were compared of the two groups of patients before and after delivery.Results The levels of ALT and HBV-DNA in the triple group were significantly decreased,and significantly lower than the double group,the difference was statistically significant( P < 0. 05). The blocking rate of the triple group was significantly higher than the double group,the difference was statistically significant( P < 0. 05). There was no significant difference in the length,head circumference,body weight,Apgar score and neonatal asphyxia between the triple and the double group( P >0. 05). Conclusion Lamivudine, hepatitis B vaccine and immunoglobulin combined using can significantly improve the blocking effect of mother to child transmission of hepatitis B,the safety is good,and the effect is better than the combined application of hepatitis B vaccine and immunoglobulin.