乙肝免疫球蛋白联合乙肝疫苗阻断乙型肝炎病毒母婴传播的效果研究

摘要

目的 研究乙肝免疫球蛋白 (HBIG)联合乙肝疫苗阻断乙型肝炎病毒 (HBV)母婴传播的效果,探讨阻断乙肝母婴传播的方法.方法 按自愿原则将随州市曾都区HBsAg阳性孕妇319例分为实验组、对照组.实验组156例孕妇,于妊娠第28,32,36周肌肉注射HBIG 200 IU及10 μg基因乙肝疫苗,新生儿出生12 h内、1月、6月龄各注射HBIG 100 IU及5 μg乙肝疫苗.对照组HBsAg阳性孕妇163例,不用药,仅新生儿出生后12 h内、1月、6月龄接种乙肝疫苗每次5 μg.所有新生儿均随访至3岁.乙肝标志物检测采用酶联免疫法,HBV-DNA病毒载量采用核酸扩增(PCR)荧光定量方法.结果 实验组新生儿宫内感染率(6.41%)低于对照组(16.57%),新生儿HBsAb阳性率(22.44%)高于对照组(4.91%),1年后实验组幼儿HBV感染率(1.28%)低于对照组(13.50%),HBsAb阳性率(95.87%)高于对照组(88.39%),以上差异均有统计学意义(P均<0.01).3年后实验组幼儿HBV感染率为1.90%,低于对照组(14.70%),差异有统计学意义(χ2=36.10,P<0.001);但实验组、对照组幼儿HBsAb阳性率差异无统计学意义.结论 应用乙肝免疫球蛋白联合乙肝疫苗,能有效地阻断乙肝母婴宫内及生长过程中的感染,提高婴儿乙肝表面抗体应答率,有效地保护儿童健康.%Objectives To study the effectiveness of hepatitis B immunoglobulin and a dose of hepatitis B vaccine in preventing mother-to-infant transmission of hepatitis B virus and to explore the approach of preventing mother-to-infant transmission of hepatitis B virus. Methods 319 HBV-positive pregnant women volunteers who were collected from township hospitals in Zengdu area Suizhou, Hubei, were divided into experimental group and control group according to their own inclination. In experimental group which contain 156 cases, the pregnant women were intramuscular injected with HBIG 200 IU and l0μg gene of hepatitis B vaccine at 28, 32,36 weeks. The infants were injected with HBIG 100 IU and 5μg of hepatitis B vaccine within 12 hours of birth, 1-month-old and 6-month-old. In control group which contain 163 cases, only the infants were infected with hepatitis B vaccine 5μg /time within 12h after birth, 1-month-old and 6-month-old. In both groups, all infants were followed up to 3 years old. Hepatitis B virus markers were tested by enzyme-linked immunosorbent assay (ELISA) and HBV-DNA load was evaluated by a highly sensitive polymerase chain reaction assay (Taq PCR). Results The intrauterine infection rate in experimental group was 6. 41 % which was lower than 16. 57 % in control group. HBsAb positive rate of neonatal in experimental group was 22. 44% which was significantly higher than 4. 91% in the control group . After one year, HBV infection rate of the infant was 1. 28% in experimental group which was lower than 13. 50% in the control group. The HBsAb positive rate of infants in the experimental group was 95. 87% which was significantly higher than 88. 39% in the control group. After 3 years, HBV infection rate of the infant in the experimental group was lower than the control groupl. 90%VS14. 70%(x2 =36. 10, P<0. 001). There was no significant differences between the experimental group and the control group in the HBsAb positive rate . Conclusions Application of hepatitis B immune globulin and hepatitis B vaccine can not only be effective in blocking HBV infection intrauterine and in the growth process, but also improve the response rate of hepatitis B surface antibody of infant which was effective in protecting children's health.