摘要
OBJECTIVE: To study the effect of different delivery modes on immunoprophylaxis efficacy so as to clarify whether or not cesarean section reduces immunoprophylaxis failure. METHODS: Mothers with positive hepatitis B surface antigen (HBsAg) were selected in the third trimester of pregnancy. Their babies were inoculated with hepatitis B immunoglobulin at birth and hepatitis B vaccine at 1, 2 and 7 months of age. HBsAg and its antibodies (anti-HBs) were tested at 1, 4, 7, and 12 months of age, then followed up yearly. RESULTS: A total of 301 babies entered the study, including 144 born by normal spontaneous vaginal delivery, 40 by obstetric forceps or vacuum extraction, and 117 by cesarean section. The incidence of mother's HBeAg positivity or baby's gender constitution was comparable between the three groups. There were no significant differences in the positive rate of anti-HBs or HBsAg at follow-up periods among the three groups. At 12 months of age, anti-HBs could be detected in 78.9% of the babies born by normal vaginal delivery, 84.6% of the babies by forceps or vacuum extraction, and 86.4% of the babies by cesarean section. The positive rate of HBsAg was 8.1%, 7.7%, 9.7%, and chronic HBV infection incidence was 7.3%, 7.7%, 6.8% respectively. CONCLUSIONS: There are no significant effects of delivery mode on the interruption of HBV maternal-baby transmission by immunoprophylaxis. Cesarean section does not reduce the incidence of immunoprophylaxis failure.
目的比较了不同分娩方式对主被动联合免疫阻断乙型肝炎病毒(HBV)母婴传播效果的影响.方法产前筛查HBsAg阳性孕妇,所生婴儿生后立即注射乙肝免疫球蛋白,记录生产方式、出生体重等,然后于1、2、7月龄接种乙肝疫苗.于生后1、4、7月及12月龄检查HBsAg和抗HBs,然后每年随访.Epi info6进行统计学处理.结果共有301名婴儿入选,其中阴道自然分娩儿童(顺产组)144名,产钳或吸引助产儿童(产钳组)40名,剖宫产儿童117名.不同分娩方式间母亲HBeAg阳性率、婴儿男女比例等情况相似 ,各月龄抗HBs阳性率、HBsAg阳性率和ALT异常率在不同分娩方式间差异无显著性.顺产组、产钳组和剖宫产组12月龄抗HBsAg阳性率分别为78.9%、84.6%和86.4%,HBsAg阳性率分别为8.1%、7.7%和9.7%,慢性HBV感染率分别为7.3%、7.7%、6.8%.各组间无显著性差异.结论分娩方式对主被动联合免疫阻断HBV母婴传播的效果无明显影响.在使用主被动联合免疫的情况下,剖宫产不能进一步降低母婴传播阻断失败的比例.
