联合免疫对乙型肝炎表面抗原阳性的慢性乙型肝炎病毒感染孕妇子女的免疫效果

目的 评价乙型肝炎疫苗（HepB）联合乙型肝炎免疫球蛋白（HBIG）对乙型肝炎表面抗原（HBsAg）阳性的慢性乙型肝炎病毒（HBV）感染孕妇子女的免疫效果.方法 326例乙型肝炎e抗原（HBeAg）阴性HBV感染孕妇及其分娩的375例子女纳入本研究,记录母亲孕期HBIG使用情况、分娩方式、子女出生后免疫预防措施和喂养方式,并进行HBV标志物比较.结果 375例子女均在出生12h内使用了HBIG,352例（93.9％）出生24 h内接种了第1针HepB,23例（6.1％）均因存在各种新生儿疾病而延迟,但分别在出生后7 ～42 d进行补接种.236例行脐带血检测HBV标志物,39例（16.5％）HBsAg阳性,197例（83.5％）HBsAg阴性,脐带血HBsAg阳性与阴性子女抗-HBs阳性率及抗-HBs中位浓度比较差异无统计学意义（P＞0.05）.孕期使用HBIG与未使用HBIG母亲的子女抗-HBs阳性率分别为63.5％（47/74）,59.8％（180/301）;剖宫产与自然分娩的子女抗-HBs阳性率分别为65.2％（103/158）,57.1％（124/217）,母乳喂养、混合喂养、人工喂养的子女抗-HBs阳性率分别为62.0％（119/192）,58.9％（63/107）,59.2％（45/76）,差异均无统计学意义（P＞0.05）.结论 HBeAg阴性HBV感染孕妇的子女经正规的HBIG联合HepB免疫预防后,不同的分娩方式、喂养方式、孕晚期是否使用HBIG对子女HepB的免疫应答与HBV的母婴传播无影响.

The immune effect of combined immunization for newborns of pregnant women with HBeAg-negative chronic hepatitis B

Objective To evaluate the immune effect of combined immunization for newborns of pregnant women with HBeAg-negative chronic hepatitis B. Methods Three hundred and seventy-five cases of children given birth by 326 cases of HBeAg -negative HBV-infected pregnant women were enrolled in this study. The usage of hepatitis B immunoglobulin （HBIG） during pregnancy, mode of delivery, the child＇s immunization measures after the birth and feeding patterns were recorded, and compared the HBV markers. Results All of 375 cases of children were given HBIG after delivery for 12 h, 352 （93.9%） cases of children were given the first time of hepatitis B vaccines（HepB） after delivery for 24 h, and 23（6.1%） cases of children were delayed because of all kinds of neonatal disease, but they were given vaccination after delivery for 7 - 42 d. Two hundred and thirty-six cases of cord blood were detected for HBV markers, 39 （16.5%） cases were HBsAg positive, 197（83.5% ） cases were HBsAg negative. The positive rate of anti-HBs and the meta-concentration of anti-HBs in the child with HBsAg positive and HBsAg negative of cord blood had no significant difference （P 〉 0.05 ）. The positive rate of anti-HBs of children whose mothers used HBIG or not during pregnancy were 63.5% （47/74）,59.8% （180/301）. The positive rate of anti-HBs in cesarean section group and the nature delivery group were 65.2% （103/158）, 57.1% （124/217）. The positive rate of anti-HBs in breast feeding, mixed feeding and artificial feeding group were 62.0% （119/192）,58.9% （63/107） ,59.2%（45/76）. There was no significant difference（P〉 0.05）. Conclusions After normal HBIG combined HepB, different mode of delivery, feeding, third trimester whether given HBIG have no effect on the newborns of pregnant women with HBeAg-negative chronic hepatitis B.