乙型肝炎病毒母婴“零传播”策略分析

Strategy analysis of eliminate mother-to-child hepatitis B virus transmission

目的探讨实现乙型肝炎病毒(HBV)母婴"零传播"的可行性策略。方法回顾性分析2005年1月至2015年12月南京市第二医院进行HBV母婴阻断治疗病例,总结母婴传播的高危因素,采取的有效阻断措施和阻断结果等。结果HBV感染孕妇不论是乙型肝炎表面抗原(+)[HBsAg(+)]、乙型肝炎表e抗原(+)[HBeAg(+)]、乙型肝炎核心抗体(+)[HBcAb(+)]还是HBsAg(+)、乙型肝炎e抗体(+)[HBeAb(+)]、HBcAb(+),只要乙型肝炎病毒脱氧核糖核酸(HBVDNA)<1.0×10^6拷贝/ml,均未发现乙型肝炎母婴传播的病例;HBVDNA≥1.0×10^6拷贝/ml的孕妇,自孕28周左右口服核苷类似物替比夫定或替诺福韦行抗病毒阻断治疗者,亦未发现乙型肝炎母婴传播的病例;HBV母婴传播仅发生在HBVDNA>1.0×10^6拷贝/ml且孕期未进行抗病毒阻断的病例;HBV感染孕妇的婴儿进行乙型肝炎疫苗及乙型肝炎免疫球蛋白(HBIG)联合免疫后,在2月龄、7月龄、12月龄检查乙型肝炎病毒表面抗体,若<100U/ml,给予加强补种一针乙型肝炎疫苗,可达到有效的乙型肝炎疫苗免疫效果。结论HBVDNA载量是乙型肝炎母婴传播的关键预测指标;对于HBV DNA高载量孕妇进行核苷类似物抗病毒治疗有效;正规及时的联合免疫,以及对乙型肝炎疫苗低应答婴儿加强疫苗接种阻断母婴传播;上述3项措施联合进行可以实现HBV母婴"零传播"。

Objective To elaborate on the feasibility strategy for achieving"zero motherto-child transmission(MTCT)of HBV".Methods This retrospective study was performed in the Second Affiliated Hospital of Southeast University from January 2005 to December 2015 to evaluate the effects of the strategy of eliminating mother-to-child HBV transmission and to summarize the highrisk factors of mother-to-child transmission.Result No cases of mother-to-child HBV transmission were found if hepatitis B surface antigen(HBsAg)or hepatitis B e antigen(HBeAg)positive mothers with HBV DNA,have HBV DNA was less than 1.0×10^6 copies/ml.If mothers with HBV DNA levels above 1.0×10^8 copies/ml managed with oral use of telbivudine or tenofovir to implement antiviral therapy from 28 weeks of gestation,there are also no cases of mother-to-child HBV transmission were found.HBV mother-to-child transmission occurred only in HBV DNA>1.0×106 copies/ml and case of not implementing antiviral therapy during pregnancy.After a birth dose of hepatitis B immunoglobulin(HBIG),in combination with hepatitis B vaccine(HepB),was used for infants born to HBV infected mothers and check the hepatitis B surface antibody(HBsAb)for infants at 2 months,7 months and 12 months,a replenish of HepB was given to strengthen the vaccine if infants with HBsAb titer was less than 100.Conclusion HBV DNA load is a key predictor of mother-to-child HBV transmission.Antiviral treatment of nucleoside analogs in pregnant women with high HBV DNA load can be effective.The combination of immunization and enhanced follow-up for infants with a low response to HepB,and strengthen vaccination if necessary to block mother-to-child transmission,can achieve"zero mother-to-child HBV transmission".