To investigate the efficacy and the roles of immune interruptions on blocking mother-to-infant transmission of hepatitis B virus (HBV) ,667 pregnant women who were seropositive for hepatitis B surface antigen (HBsAg) were enrolled. According to the lab test results of HBV e antigen (HBeAg) and HBV DNA in the mothers, the mothers were divided into either HBeAg-positive group or HBeAg-negative group, and either HBV DNA-positive group or HBV DNA-negative group. Depending on whether the mothers were receiving hepatitis B immunoglobulin (HBIG) once a month during the third trimester of pregnancy, they were divided into either the HBIG-receiving group or the non-HBIG-receiving group. All infants received regular passive and active HBV immunization after birth. Infant serum HBV markers were determined 8-12 months after birth. Twenty infants born to HBsAg-positive mothers were infected with HBV and the failure rate of immune interruptions was 3.0%. The failure rate of immune interruptions in the HBeAg-positive group was 8.7%, which was significantly higher than that observed in HBeAg-negative group 0.2% (P<0. 001). However, the HBV surface antibody (HBsAb) positive rates of the infants between the two groups were not statistically different (P = 0. 988). The overall failure rate of immune interruptions of infants born to the HBV DNA-positive group was 8.1%, and the infants infected with HBV were all born to the mothers whose serum HBV DNA levels were above 6 logio copies/ml. There were no statistical differences in the incidence of perinatal HBV infection between mothers receiving HBIG and those not receiving HBIG (3.7% vs 2. 7%, P = 0. 479). No statistical differences were seen in HBsAb positive rates versus vaccination of the infants between the two groups (84.4% vs 82. 4%, P - 0. 519). Among HBeAg-positive pregnant women receiving HBIG, the failure rate of immune interruptions in their infants was 8.4%, compared with 8.9% in those who did not receive HBIG, with no statistical differences (P = 0.892). Importantly, 10 out of 11 infants who were infected with HBV were already serum HBsAg-positive immediately after birth, suggesting intrauterine infection either via venous or cord blood. These results indicate that preventative vaccine immunization plus HBIG administration does not block intrauterine transmission of HBV. Approaches to decrease the serum HBV DNA load in pregnant women by antiviral treatment may efficiently block mother-to-infant transmission.%阻断乙型肝炎病毒(HBV)母婴传播是控制乙型肝炎的重大问题.为探讨免疫预防对阻断HBV母婴传播的效果及影响因素,对667例HBV表面抗原(HBsAg)阳性孕妇及其婴儿进行研究.这些孕妇按HBV e抗原(HBeAg)和HBV DNA检测结果,分为HBeAg阳性组及阴性组、DNA阳性组及阴性组；按是否于孕晚期注射乙型肝炎免疫球蛋白( HBIG),分为注射组及未注射组.婴儿于出生24 h内均肌内注射HBIG100IU,并按0、1、6方案注射10 μg重组酵母HBV疫苗;8～12月龄后随访婴儿,并进行HBV标志物(HBV-M)检测.667个婴儿中,20例感染HBV,免疫阻断失败率为3.0％.孕妇HBeAg阳性组免疫阻断失败率为8.7％,阴性组为0.2％,两组差异显著(P＜0.001)；两组婴儿对疫苗免疫应答率分别为83.0％和83.1％,无显著差异(P=0.988).孕妇DNA阳性组免疫阻断失败率为8.1％,HBV DNA均≥6 log10 copies/ml.孕期注射与未注射HBIG组婴儿免疫阻断失败率分别为3.7％和2.7％,无显著差异(P=0.479)；两组婴儿对疫苗免疫应答率分别为84.4％和82.4％,无显著差异(P=0.519).孕妇HBeAg阳性注射HBIG组与未注射组的免疫阻断失败率分别为8.4％和8.9％,无显著差异(P=0.892).孕妇HBeAg阴性注射与未注射HBIG组的免疫阻断失败率分别为0.0％和0.3％,也无显著差异(P=0.538).11例免疫阻断失败的婴儿中,10例出生时血清HBsAg已为阳性;8～12个月后随访,HBsAg仍持续阳性,提示为宫内感染.本研究证实,孕期注射HBIG未能提高婴儿对HBV疫苗加HBIG的免疫阻断效果.宫内感染可能是疫苗加HBIG免疫阻断失败的主要原因.采用降低孕妇血清HBV DNA的措施,如对孕妇进行抗HBV治疗,也许能降低HBV宫内感染率.
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