乙肝表面抗原阳性孕妇肌注乙肝免疫球蛋白预防母婴 …

目的 探讨经母亲对胎儿行被动免疫在预防直炎病毒（ＨＢＶ）宫内感染中的作用。方法 对自孕２０周起多次肌注乙肝免疫球蛋白（ＨＢＩＧ）的ＨＢｓＡｇ（＋）孕妇３４例（Ａ组）及未注射的１４例ＨＢｓＡｇ（＋）孕妇（Ｂ组），用固相放免法和套式ＰＣＲ检测母血ＨＢｓＡｇ、ＨＢＶ ＤＮＡ及其新生儿血ＨＢｓＡｇ、抗ＨＢＳ、ＨＢＶ ＤＮＡ。结果 Ａ组３５例新生儿中３２例血甭ＨＢＳ（＋），与Ｂ组相比具有显著差异（Ｐ〈０．０     

孕妇主动与被动联合免疫预防乙型肝炎病毒宫内感染的临床研究

目的 探讨孕妇主动与被动联合免疫预防乙型肝炎病毒（ＨＢＶ）宫内感染的作用和机理。方法 将５３例ＨＢｓＡｇ（＋）孕妇分成两组，预防组３０例，自孕２０周起多次注射乙肝疫苗（ＨＢＶａｃ）和乙肝免疫球蛋白（ＨＢＩＧ）；对照组２３例，不用ＨＢＶａｃ和ＨＢＩＧ。母儿血清ＨＢｓＡｇ，ＨＢｅＡｇ和抗－ＨＢｓ用固相放免法检测，ＨＢＶ－ＤＡＮ用套式ＰＣＲ检测。结果 预防组新生儿血清ＨＢｅＡｇ和ＨＢＶＤＮＡ检出率明显低     

对乙型肝炎易感婴幼儿接种乙肝疫苗后的调查研究

对乙型肝炎易感婴幼儿接种乙肝疫苗后的调查研究刘芸，宋岩峰，余江（福建省福州东方医院）为保护ＨＢｓＡｇ携带者所生的婴幼儿，我们用ＥＬＩＳＡ检测ＨＢＶ５项标志物及用聚合酶链反应（ＰＣＲ）技术检测ＨＢＶ ＤＮＡ，探讨ＨＢｓＡｇ阳性产妇所生婴幼儿接种血源乙肝...     

乙肝免疫球蛋白联合乙肝疫苗对阻断HBV母婴传播效果探析

目的：探讨乙肝免疫球蛋白和乙肝疫苗联合免疫对于阻断HBV母婴传播的效果。方法：选择2011年1月至2011年6月间于我州县级以上医院就诊的乙肝表面抗原（HBsAg）和e抗原（HBeAg）双阳性的乙肝孕母及其新生儿为研究对象，按免疫程序的不同分为A、B、c三组。A组母亲在分娩前三个月，每月均注射一次乙肝免疫球蛋白（HBIG），每次2001U，新生儿分别于0周和2周注射一次HBIG，每次200IU；B组新生儿分别于0周和2周注射一次HBIG，每次200IU；C纽孕母和新生儿均不注射HBIG。所有婴儿均按国家的免疫规划程序接种乙肝疫苗，即0、1、6月注射乙肝疫苗。观察并对比婴儿在6个月时乙肝五项结果。结果：三组婴儿在6个月时的乙肝表面抗体阳性率、保护性抗体产生率不同，A组婴儿的表抗阳性率低于其它两组，且保护性抗体产生率高于其他两组，差异有统计学意义（P〈0．05）。结论：乙肝免疫球蛋白和乙肝疫苗联合免疫方案对于阻断HBV的垂直传播有较好的效果。     

血HBsAg,HBeAg阳性孕妇外周血单个核细胞HBV感染的研究

目的：探讨ＨＢｓＡｇＨＢｅＡｇ阳性孕妇外周血单个核细胞（ＰＢＭＣ）的乙型为病毒（ＨＢＶ）感染状况及其宫内传播中的作用。方法对５２例ＨＢｓＡｇ、ＨＢｅＡｇ阳性孕妇ＰＢＭＣ进行ＨＢＶＤＮＡ的聚合酶链反应（ＰＣＲ０检测。同时检测其所生婴儿血清中的ＨＢｓＡｇ。孕妇于分娩前、新生儿于出生时分别抽外周血作血清学检测。结果：５２例孕妇ＰＢＭＣＨＢＶ感染率为４６．２％（２４／５２），与孕妇ＨＢｓＡｇ滴度呈正相关。     

乙型肝炎血清学指标阳性母亲哺乳问题的研究

检测６１例乙型肝炎（乙肝）血清学指标阳性的母亲，初乳中乙型肝炎病毒（ＨＢＶ）标志物及ＨＢＶＤＮＡ，分析从各类指标检出的阳性率与哺乳能否传播乙肝的相关性，并发现母血中传播性大的三项标志物为：乙型肝炎表面抗原（ＨＢｓＡｇ）、乙型肝炎ｅ抗原（ＨＢｅＡｇ）及乙型肝炎核心抗体（抗－ＨＢｃ），这几项标志物极易进入乳汁。而乙型肝炎表面抗体（抗－ＨＢｓ）及乙型肝炎ｅ抗体（抗－ＨＢｅ）却不易进入乳汁。６１份标本的ＨＢＶＤＮＡ阳性率（总排毒率）为４２．６％。母血和初乳不同ＨＢＶ标志物阳性组在相关的初乳中的排毒率呈高度一致性；母血中ＨＢｓＡｇ、ＨＢｅＡｇ、抗－ＨＢｃ三项阳性、ＨＢｅＡｇ及抗－ＨＢｃ、ＨＢｓＡｇ及抗－ＨＢｃ、ＨＢｓＡｇ及ＨＢｅＡｇ和ＨＢｅＡｓ阳性组初乳中的排毒率明显高于抗一ＨＢｓ和（或）抗－口ＨＢｅ阳性组。     

胎盘乙型肝炎病毒感染与宫内传播的关系

目的 探讨乙型肝炎病毒（ＨＢＶ）宫内传播的危险因素,并追踪ＨＢＶ经胎盘传播的途径和胎儿宫内感染的时间,方法 共收集了乙型肝炎表面抗原（ＨＢｓＡｇ）携带孕妇１３１例,其中孕早期人工流产胎盘２４例,孕中期引产胎盘和胎儿各６例,足月分娩胎盘和新生儿各１０１例。孕妇和新生儿血清ＨＢｓＡｇ和ＨＢＶ ＤＮＡ检测分别采用酶联免疫吸附试验和聚酶链反应法。     

乙型肝炎疫苗和乙肝免疫球蛋白阻断乙肝病毒母婴传播的效果

目的:调查实际应用中免疫预防阻断乙型肝炎病毒(HBV)母婴传播的效果,观察孕期注射乙肝免疫球蛋白(HBIG)能否减少HBV母婴感染。方法:对2006年1月至2010年12月在镇江市妇幼保健院分娩的224例乙肝表面抗原(HBsAg)阳性母亲以及250例儿童,结合住院病历,进行回顾性调查,记录母亲孕期HBIG使用情况、子女出生后HBIG和乙型肝炎疫苗接种资料,并采血检测HBV血清标志物及谷丙转氨酶(ALT)。其中69例儿童出生后免疫预防前采外周血检测HBV血清标志物。结果:250例HBsAg阳性孕妇的子女随访时年龄(3.3±1.6)岁,出生时检测HBV标志物的69例中,4例HB-sAg阳性,其中2例随访时HBsAg仍阳性,乙型肝炎e抗原(HBeAg)也阳性,说明慢性感染,另外2例HBsAg转阴;1例出生时HBsAg阴性,但随访时转为阳性。另1例出生时未检测,随访时HBsAg阳性。因此共4例(1.6%)慢性感染HBV,其母亲均为HBeAg阳性。4例感染儿童中,2例出生时未注射HBIG,且未正规接种疫苗。随访的224例母亲中,215例明确孕期使用HBIG的情况;76例子女的母亲孕期注射了HBIG,1例(1.3%)HBsAg阳性,142例子女的139例母亲孕期未使用HBIG,3例(2.1%)HBsAg阳性(P>0.05)。结论:HBsAg阳性孕妇的子女经正规免疫预防后,HBV母婴阻断效果良好,部分预防失败是由于未实施正规预防。新生儿出生时HBV血清标志物不能作为诊断是否感染HBV的指标。孕晚期使用HBIG对阻断母婴感染无效。     

替比夫定防止134例胎儿宫内乙型肝炎病毒感染的疗效研究

目的：替比夫定阻断妊娠中晚期胎儿宫内感染乙型肝炎（简称乙肝）病毒（HBV）的疗效及安全性研究。方法：选择2009年1月—2011年1月在武汉市江夏区第一人民医院就诊的确诊为合并慢性乙肝的妊娠中晚期患者134例,基于患者意愿,分为治疗组（86例）和对照组（48例）。妊娠22-32周,治疗组口服替比夫定抗病毒治疗,对照组口服复方甘草酸苷片治疗。足月分娩时均抽取脐带血检测乙肝全项,24 h内给新生儿各注射乙肝疫苗10μg及乙肝免疫球蛋白200 IU,同时序贯给予乙肝疫苗免疫。结果：治疗前2组患者年龄、孕周、HBV拷贝数、血丙氨酸转氨酶（ALT）和天冬氨酸转氨酶（AST）差异无统计学意义（均P〉0.05）。经过替比夫定治疗后,治疗组患者分娩时HBV拷贝数下降,肝功能好转,产后出血发生率降低（均P〈0.05）。治疗组新生儿出生时脐带血HBV感染率低于对照组（P〈0.05）,但2组新生儿肝功能均正常（P〉0.05）。不同分娩方式新生儿1年后HBV感染率差异无统计学意义（χ2CMH=0.067 8,P=0.794 5）。结论：口服替比夫定阻断乙肝宫内感染治疗安全有效,值得进一步推广。     

母血乙型肝炎表面抗原滴度与其新生儿宫内感染的关系

乙型肝炎病毒（ＨＢＶ）存在宫内感染的传播途径，用乙肝疫苗和乙肝高效价免疫球蛋白难以阻断［１］。发生宫内感染的婴儿生后大部分将发展成为乙肝病毒慢性携带者，ＨＢＶ宫内感染的原因及预防措施一直是人们关注的问题。本文通过检测孕妇分娩前血清中乙型肝炎表面抗原（...     

胎儿感染乙型肝炎病毒的临床研究

目的　探讨临床诊断胎儿感染乙型肝炎病毒 (HBV)的方法 ,及其与各种临床因素的相互关系。方法　采用聚合酶链反应 (PCR)及斑点杂交法 ,检测 14 1例HBV携带者孕妇及其分娩的 14 4例新生儿静脉血HBVDNA、HBV标志物及肝功能。其中 4 0例新生儿同时留取脐带血及出生后 2 4～4 8h外周静脉血用于检测HBVDNA。 14 4例新生儿根据有无HBV感染分为胎儿感染组及对照组 ,比较两组新生儿的临床资料及其肝转氨酶水平。结果　 (1) 14 4例新生儿中有 33例发生宫内HBV感染(胎儿感染组 ) ,感染率为 2 2 9% ;无宫内HBV感染 111例 (对照组 )。 4 0例新生儿脐血与外周静脉血HBVDNA阳性率相比 ,脐血的假阳性率为 2 0 0 % ,其敏感性、阳性预测值分别为 10 0 0 %、80 0 %。追踪HBV携带者孕妇所分娩的新生儿出生 6～ 9个月后 ,HBVDNA持续阳性者 7例 (7/2 8) ,抗 HBs转阳率为 85 3% ;出生时HBsAg阳性者 5例 ,均于 1个月后转为阴性。 (2 )在HBeAg或HBVDNA阳性孕妇中 ,其胎儿感染率分别为 70 5 %、6 1 1% ,显著高于HBeAg或HBVDNA阴性者的 2 0 % (2 /10 0 )、0 0 %(P <0 0 1)。胎儿感染组与对照组孕妇 ,在年龄、孕周、分娩方式、出生体重、身长、出生 1分钟Apgar评分等比较 ,差异均无显著性 (P >0 10 )。 (3)胎儿感染组天     

新生儿乙型肝炎病毒血清标志物检测及其转归

目的探讨乙型肝炎病毒携带产妇所生新生儿血清乙型肝炎病毒标志物(HBV-M)转归。方法2001年3月至2006年3月在暨南大学附属第一医院进行产前检查的500例HBsAg阳性产妇所生新生儿，根据母亲HBeAg状态分为HBeAg阳性组144例，HBeAg阴性组356例。两组新生儿在出生12 h内均注射乙型肝炎免疫球蛋白100 IU，并按常规0、1、6方案分别在出生时、1月龄和6月龄注射基因重组乙型肝炎疫苗5 μg，注射主被动免疫前分别抽取外周静脉血检测HBV-M。结果两组新生儿出生时外周血HBsAg、HBeAg均阳性者分别为24例和9例，追踪至6月龄时HBsAg阳性例数分别为10例和5例，HBsAg阴转率差异无统计学意义。两组新生儿出生时HBsAg阳性、HBeAg阴性者分别为4例和21例，追踪至6月龄时，HBsAg阴转率分别为100%和85.7%。出生时HBsAg阴性、HBeAg阳性者，HBeAg阳性组为29例，占20.1%，显著高于HBeAg阴性组比例(P<0.01)，其6月龄HBsAg阳转率为6.9%，明显低于HBeAg阴性组(P<0.01)。在接受全程主被动免疫的情况下，HBeAg阳性组新生儿6月龄HBsAg和HBsAb阳性率分别为9.7%和67.4%，HBeAg阴性组分别为3.1%和78.1%，两组比较差异有统计学意义(P<0.05)。结论新生儿出生时外周血HBsAg阳性不能作为判断宫内感染的指标，HBeAg阳性新生儿预后与母亲HBeAg状态密切相关，母亲HBeAg阳性会抑制新生儿对乙型肝炎疫苗的反应。     

Breast feeding and immunoprophylaxis efficacy of mother-to-child transmission of hepatitis B virus

Abstract

Objective: This study was designed to explore if hepatitis B virus (HBV) may be transmitted via breast milk through mother-to-child transmission (MTCT), and assay the immunoprophylaxis efficacy after passive–active immunization.

Method: From year 2008 to 2012, 67?720 pregnant women were screened and 1186 HBsAg-carrier mothers and their infants aged 8–12 months were followed in multi-centers of China, among whom HBV markers (HBsAg, HBsAb, HBeAg, HBeAb and HBcAb) and HBV-DNA were measured.

Results: HBsAg positive rate of pregnant women was 6.7% (4533/67?720) and infants’ immunoprophylaxis failure rate was 3.3% (39/1186). Immunoprophylaxis failure infants were all born to mothers of HBeAg positive and HBV-DNA >6 log₁₀ copies/ml. Among infants of HBeAg positive mothers, HBV infection rate was 9.0% and HBsAg positive rate was 8.3% in breast-feeding group versus 9.2% in formula-feeding group, P?=?0.761. Occurrence of perinatal HBV infection was indicated in uterus or during delivery. Different feeding patterns had no effects on HBsAb conversion of infants with the implementation of immunization.

Conclusions: HBsAg prevelance rate of pregnant women enrolled was 6.7% and immunoprophylaxis failure rate of infants was 3.3%, while the infection rate reached 9.0% in infants of HBeAg positive mothers. Breast feeding did not increase the occurrence of HBV MTCT.     

常规免疫预防阻断乙型肝炎病毒母婴感染的效果

目的 评价免疫预防措施在实际应用中阻断乙型肝炎病毒(hepatitis B virus,HBV)母婴感染的效果,阐明孕妇孕晚期使用乙肝免疫球蛋白(hepatitis B immunoglobulin,HBIG)能否减少HBV母婴感染.方法 将2002年7月至2004年8月江苏省14个县市的419例乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)阳性孕妇所分娩子女作为研究组,同地区同期的453例 HBsAg-孕妇分娩的子女作为对照组,于2009年10月至2010年3月期间对2组研究对象进行随访,调查母亲孕期HBIG使用情况以及子女出生后HBIG和乙型肝炎疫苗接种情况,检测儿童HBV血清标志物.率的比较采用χ2分析或者Fisher精确概率法,均数的比较采用t检验.结果研究组实际随访298例(71.12%),其中11例(3.69%) HBsAg+;而随访的328例(72.41%)对照组中,HBsAg阳性率为0.00 (χ2=12.32,P<0.01).共11例儿童HBsAg+,其母亲均为HBsAg和HBeAg同时阳性,除1例具体情况不详外,9例儿童在出生时明确没有使用HBIG或延迟接种疫苗,仅1例同时规范使用了HBIG和乙型肝炎疫苗.2组儿童抗-HBs阳性率分别为69.46%和69.21% (χ2=0.01,P=0.95).孕晚期注射HBIG的92例孕妇中,2例(2.17%)儿童HBsAg+;未使用HBIG的197例孕妇中,9例(4.57%)儿童HBsAg+ (χ2=0.98,P=0.51).结论 江苏省常规免疫预防措施在阻断母婴HBV感染方面取得了良好的效果,但对HBV携带孕妇(特别是HBeAg+者)的新生儿仍需强调及时注射HBIG.孕妇孕晚期使用HBIG不能减少母婴HBV感染.

Abstract：

Objective To assess the protective effect of vaccination in routine application on hepatitis B virus (HBV) exposed infants and to clarify whether hepatitis B immunoglobulin (HBIG) administration of pregnant women may reduce the risk of maternal-fetal transmission of HBV. Methods Serum samples of 6398 pregnant women at gestation of 15-20 weeks from 6 urban and 8 rural areas across Jiangsu province were previously tested for serologic markers of HBV by ELISA from July 2002 to August 2004. In this study, infants born to 419 HBV carrier mothers were taken as the study group, while infants born to 453 non-carrier mothers were taken as the control group by stratified random sampling. They were followed-up and screened for HBV markers during October 2009 to March 2010. Information including HBIG administration during pregnancy, HBV vaccination and HBIG administration of the infants were collected. χ2 test or Fisher′s exact method were used to compare the rates and the comparison of the means was by t test. Results The follow-up rates of the study group and control group were 71.12% (298/419) and 72.41% (328/453), respectively. Of the 298 infants born to HBV carrier mothers, 11 (3.7%) were positive for HBsAg, while none of the 328 infants born to non-carrier mothers was HBsAg positive (χ2=12.32, P<0.01). All of the 11 children were born to mothers with both HBsAg and HBeAg positive, and nine of the 11 children were not injected HBIG or not immunized with hepatitis B vaccine within 24 hours after birth, with only one received regular vaccination and detailed information was unknown in one case. The positive rates of anti-HBs in the study group and the control group were 69.46% and 69.21% respectively (χ2=0.01, P=0.95). HBsAg positive rate of the children born to pregnant women treated with HBIG during late pregnancy (n=92) was 2.17% (n=2), whereas that in the children born to women not treated with HBIG (n=197) was 4.57% (χ2=0.98, P=0.51). Conclusions The protective effect of immunoprophylaxis in routine application against perinatal HBV infection in Jiangsu province is good. Efforts are required to emphasize the importance of HBIG administration in infants born to HBV carrier mothers, especially in HBeAg positive mothers within 24 hours after delivery. Treatment of HBsAg positive pregnant women with HBIG in third trimester would not decrease the risk of maternal-fetal transmission of HBV.     

妊娠合并乙型肝炎病毒感染孕妇胎儿窘迫发病原因分析

目的：探讨妊娠合并乙型肝炎病毒（HBV）感染孕妇胎儿窘迫的病因、预后及治疗方法。方法：对81例妊娠期HBV表面抗原（HBsAg）、HBVe抗原（HBeAg)、HBV核心抗体（HBcAb)和HBV DNA均阳性,肝功能正常的孕妇及其新生儿（研究组）,85例无肝炎病毒感染,肝功能正常的孕妇及新生儿（对照组）的临床资料、血清学检查结果、胎盘病理检查结果和胎儿预后进行分析,并对研究组中76例婴儿在出生后0、1、6月龄时分别注射酵母菌重组乙型肝炎疫苗10μg,24月龄时检测婴儿HBV表面抗体（HBsAb),以评价母婴HBV阻断效果。结果：（1）研究组胎儿窘迫的发生率为38．3％,对照组为16．5％,两组比较差异有显著性（P＜0．05）。（2）HBV感染胎盘可导致绒毛膜血管病。（3胎儿窘迫者,24月龄时母婴阻断率为78．6％,无胎儿窘迫者母婴HBV阻断率为91．7％,两 者比较,差异有显著性（P＜0．05）。结论：妊娠合并HBV感染,可引起胎盘绒毛膜血管病,致使胎盘功能下降,临床表现为胎儿窘迫、进而导致HBV母婴阻断失败。     

免疫阻断乙型肝炎病毒母婴传播多中心研究

目的 探讨孕产妇乙型肝炎表面抗原（HBsAg）阳性率及乙型肝炎病毒（HBV）母婴传播阻断的效果。方法 2008－2012年,通过多中心队列研究,对湖北省、山西省、广东省、新疆维吾尔自治区等地的孕产妇进行HBsAg筛查;对上述地区部分医院入院分娩的HBsAg阳性母亲及8～12个月龄婴儿进行随访观察,所有标本检测乙型肝炎血清标志物(HBsAg,HBsAb,HBeAg,HBeAb,HBcAb),部分标本检测HBV DNA。结果　筛查孕妇82214例,HBsAg阳性4924例,阳性率6.0%。随访HBsAg阳性母亲及8～12个月龄婴儿1371对,婴儿免疫阻断失败率3.1%（42/1371）,HBsAg及HBeAg双阳性母亲婴儿的免疫阻断失败率为8.2%。免疫阻断失败的婴儿其母亲均为HBeAg阳性且HBV DNA≥6 log10 copies/mL。HBeAg阳性母亲孕期注射乙型肝炎免疫球蛋白(hepatitis B immune globulin, HBIG)及未注射HBIG组,其婴儿免疫阻断失败率差异无统计学意义(8.8% vs. 8.1%, P=0.807)。结论　多中心调查显示目前孕产妇HBsAg阳性率6.0%,HBV母婴阻断失败率3.1%。HBsAg及HBeAg双阳性且HBV DNA≥6 log10 copies/mL 的孕妇应为母婴阻断的重点人群。孕妇孕期注射HBIG不能提高HBV母婴阻断效果。     

孕妇HBsAg阳性对新生儿初次免疫后三年内乙肝表面抗体稳定性的影响

目的 探讨孕妇HBsAg阳性对其新生儿出生后3年内乙肝表面抗体(HBsAb)稳定性的影响,观察定期检查和及时加强/重复免疫对维持儿童乙肝疫苗免疫效果的作用.方法 对20例HBsAg阴性孕妇及24例HBsAg阳性孕妇分娩的新生儿初次全程乙型肝炎基因疫苗免疫效果进行3年的随访,对儿童中有HBsAb滴度下降至低于保护性滴度或转阴者(即不稳定者)及时复种,比较两组儿童HBsAh不稳定者所占比例,比较初次免疫后1个月及3岁时HBsAb的阳性率.结果 孕妇HBsAg阴性及孕妇HBsAg阳性两组儿童HBsAb不稳定者所占比例分别为[20.0%(4/20)和79.2%(19/24,),P<0.05];两组HBsAb阳性率在7月龄时分别为100.0%(20/20)和62.5%(15/24)(P<0.05),3岁时分别为85.0%(17/20)、91.7%(22/24)(P>0.05).结论 孕妇HBsAg阳性将降低其新生儿初次全程免疫后3年内HBsAb稳定性,通过每间隔半年至一年的定期检查和及时加强/重复免疫可维持乙肝疫苗免疫效果.     

乙型肝炎表面抗原与乙型肝炎e抗原阴性孕妇乙型肝炎病毒宫内感染的研究

目的 探讨应用套式PCR方法检测乙型肝炎表面抗原(HBsAg)及乙型肝炎e抗原(HBeAg)阴性孕妇乙型肝炎病毒(HBV)宫内感染的状况。方法 选择HBsAg与HBeAg阴性,其他HBV血清标志物阳性孕妇及其新生儿24例作为病例组,同期HBV血清标志物全部阴性孕妇及其新生儿16例作为对照组。采用套式PCR方法检测两组孕妇及其新生儿的血清及外周血单个核细胞(PBMC)中HBV-DNA。结果(1)病例组24例孕妇中,血清HBV-DNA阳性8例,阳性率为33％;PBMC中HBV-DNA阳性10例,阳性率为42％r。其中血清与PBMC均阳性3例,总阳性率为63％r(15／24)。(2)病例组24个新生儿中,血清HBV-DNA阳性3例,阳性率为13％,PBMC中HBV-DNA阳性6例,阳性率为25％。其中血清与PBMC均阳性1例,宫内感染率为33％(8／24)。(3)病例组24例孕妇中,血清阴性而PBMC阳性共7例,其新生儿4例发生宫内感染,感染率为4／7。(4)对照组16例孕妇及其新生儿血清及PBMC中HBV-DNA全部阴性。结论 HBsAg及HBeAg阴性孕妇也可发生HBV宫内感染,采用灵敏度高的套式PCR方法检测孕妇及其新生儿血清及PBMC中HBV-DNA,对诊断HBV宫内感染具有重要临床意义。     

Prevention of vertical hepatitis B transmission by hepatitis B immunoglobulin in the third trimester of pregnancy.

OBJECTIVE: To explore the possible efficacy of using hepatitis B immunoglobulin (HBIG) during the third trimester of pregnancy to prevent intrauterine transmission of hepatitis B virus (HBV). METHODS: Of 469 pregnant women testing positive for hepatitis B surface antigens (HBsAg), 126 had hepatitis B e antigen (HBeAg) and 343 did not. RESULTS: There were women who declined to be treated with HBIG in these 2 groups. Among infants born to HBeAg-positive mothers, the rates of those testing positive for HBsAg at birth and at the 6-month visit were significantly lower when the mothers had been treated with HBIG (P<0.05). Among infants born to HBeAg-negative mothers, however, no significant differences were found whether the mothers had been treated or not. Furthermore, all newborns received HBIG treatment and the first dose of a vaccination schedule within 12 h of birth. At the 6-month visit the protective anti-HBs rates were only 32.3% among infants whose mothers were HBeAg-positive and 56.2% among those whose mothers were HBeAg-negative when their mothers had not been treated with HBIG during pregnancy, whereas the corresponding rates were as high as 75.8% and 88.7% when the mothers had been treated. CONCLUSION: Maternal administration of HBIG is effective in preventing intrauterine fetal HBV infection in HBsAg-positive, HBeAg-positive pregnant women and in improving immune response to hepatitis B vaccine in infants born to HBV carriers.     

Prevention of hepatitis B infection in infants born to hepatitis B carrier mothers: low dosage vaccination

Two groups of newborn infants born to HBeAg positive carrier mothers were given HBIG (200 IU) immediately after birth. Subsequently, at age 2 days and at 1, 2 and 12 months, the first group received 5 microgram and the second group 2 microgram of HBV vaccines. There was no significant difference in the anti-HBs seroconversion rate (SR), and the protective efficacy rate (PER) at the age of 13 months in either group. The SR and PER of group 1 were 91.7% and 90.18%, and group II were 92.9% and 91.01%, respectively. Although the significant differences were observed in the geometric mean titers of anti-HBs in group I (526.3 mIU/ml) and group II (371.4 mIU/ml), both were above the protective level. The immune responses to the reduced dosage of HBV vaccines are satisfactory in preventing HBV in the newborn infants of HBeAg positive carrier mothers.