穴位注射乙型肝炎免疫球蛋白阻断乙型肝炎病毒母婴传播的临床研究

目的　探讨乙型肝炎病毒 (HBV) 阳性孕妇孕期足三里穴位注射乙型肝炎免疫球蛋白 (HBIg) 预防HBV宫内感染的作用效果。方法　2001年 11月~2003年 10月青岛大学医学院附属烟台毓璜顶医院将 190例乙肝表面抗原 (HBsAg) 阳性孕妇分为两组: 足三里穴位注射组 92例, 于孕 20、24、28、32、36周足三里穴位注射HBIg共 5次, 每次 200IU。肌肉注射组 98例, 于相同时间肌肉注射HBIg。采用酶联免疫法, 检测用药前、后孕妇血清及新生儿脐血清的HBsAg、HBeAg及HBsAb, 采用核酸扩增 (PCR) 荧光定量法检测HBV-DNA含量。结果　92例足三里穴位注射者, 新生儿宫内感染 8例, 宫内感染率为 8 7%, 低于肌肉注射组 (P<0 01)。穴位注射组新生儿脐血清HB sAb检出率显著高于肌肉注射组 (P<0 05)。穴位注射组临产前血清中HBV-DNA含量显著低于肌肉注射组 (P<0 05)。结论　孕妇通过足三里穴位注射HBIg, 可有效减少HBV的宫内感染, 未发现任何副作用。

Clinical Study of Interrupting HBV Maternal-Infantile Intrauterine Infection by Acupoint Injection of Hepatitis B Immunoglobulin

Objective To study the effect and possible mechanism of acupoint injection of hepatitis B immuobulin(HBIg) during pregnancy in preventing intrauterine HBV infection.Methods 190 cases of HBsAg positive pregnant women with HBeAg positive were divided into two groups.In the acupoint injection group,92 cases were injected HBIg into acupoint at 20,24,28,32,36 week during pregnancy (200 IU per time).Each subject in the intramuscular injection group (98 cases) received 200 IU of HBIg intramuscularly (IM) at the same gestation.Blood samples were taken before and after HBIg injection in all pregnant women and their infants,umbilical blood were taken at birth.HBsAg,HBeAg,Anti-HBs and HBV-DNA load in the blood samples of pregnant women and their neonates were tested respectively by using enzyme linked immunosorbant assay (ELISA) and polymerase chain reaction (PCR).Results The incidence of HBV intrauterine infection was 8.70% (8/92).In the acupoint injection group,the vertical transmission incidence of the newborns was lower in the acupoint injection group than that in the intramuscular group (P<0.01).The detection rate of anti-HBs of the newborns in the acupoint injection group was significantly higher than that in the intramuscular injection group (P<0.05).Whereas,serum HBV-DNA load was significantly lower before parturience in the acupoint injection group than that in the intramuscular injection group (P<0.05).Conclusion Acupoint injection of HBIg during pregnancy can reduce the incidence of HBV intrauterine infection effectively and without any side effects.