母乳喂养不影响乙型肝炎病毒母婴传播阻断效果

目的：比较不同喂养方式对HBsAg阳性母亲的婴儿母婴传播阻断效果的影响。方法：HBsAg阳性母亲的婴儿常规接种乙型肝炎疫苗或接受乙型肝炎疫苗和乙型肝炎免疫球蛋白联合免疫并随访。62例婴儿单用乙型肝炎疫苗免疫，21例母乳喂养，41例人工喂养；168例婴儿联合免疫，33例母乳喂养，135例人工喂养。结果：单用疫苗时1、3、6、12月龄抗-HBs阳性率母乳喂养组分别为4.8％、42.9％、57.9％、80.9％，人工喂养组分别为12.2％、26.3％、60.5％、73.2％；联合免疫时1、4、7、12月龄抗-HBs阳性率母乳喂养组分别为72.7％、75.8％、77.4％、90.9％，人工喂状组为77.0％、72.9％、76.2％、90.4％。单用疫苗时，母乳喂养组1例、人工喂养组3例免疫失败；联合免疫时，母乳喂养组无一例免疫失败，人工喂养组4例免疫失败，母乳喂养和人工喂养比较，差异均无显著性。结论：母乳喂养不影响抗-HBs产生，不增加免疫失败。     

乙型肝炎病毒携带者母乳喂养的研究

目的探讨乙型肝炎(乙肝)病毒(hepatitis B virus，HBV)携带者在其新生儿、婴儿接受被动及主动全程联合免疫的条件下，是否可以母乳喂养。方法对2001年9月至2003年10月间妊娠期无症状HBV携带者所娩婴儿进行前瞻性随访研究，新生儿出生时留取脐血检测HBV脱氧核糖核酸(HBV DNA)，出生后12h内及第14天注射乙肝免疫球蛋白，并按0、1、6的程序全程接种乙肝疫苗，由产妇自愿选择母乳喂养或人工喂养，55例母乳喂养，36例人工喂养。分别于婴儿7个月和12个月时随访检测HBV DNA及乙肝血清标志物，婴儿7个月时未感染乙肝但抗-HBs阴性者给予乙肝疫苗5μg加强注射。结果婴儿7个月和12月时，母乳喂养组HBV DNA阳性率分别为9．09％(5／55)及9．09％(5／55)，抗HBs阳性率分别为85．45％(47／55)及90．90％(50／55)；人工喂养组HBVDNA阳性率分别为8．33％(3／36)及8．33％(3／36)，抗HBs阳性率分别为86．11％(31／36)及91．67％(33／36)。母乳喂养与人工喂养相比，差异均无统计学意义。结论在新生儿、婴儿接受被动及主动全程联合免疫的条件下，无症状HBV携带者可以母乳喂养。     

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。     

553例产妇血清、乳汁、唾液中乙型肝炎病毒-DNA载量的检测及相关性研究

目的:探讨乙型肝炎病毒(HBV)携带产妇血清中HBV标志物感染模式(HBV-M)、HBV-DNA载量与乳汁、唾液中HBV-DNA阳性率的关系,为安全进行母乳喂养和母婴亲密接触提供循证医学依据。方法:选取467例HBV携带产妇(实验组,又分为大三阳组、小三阳组和单纯阳性组)和同期86例乙型肝炎五项指标全阴的产妇(对照组),用ELISA和实时荧光定量多聚酶链反应(PCR)方法,检测产妇血清HBV-M及血清、乳汁、唾液中HBV-DNA载量,分析乳汁、唾液中HBsAg阳性率、HBV-DNA阳性率与血清HBV-M的关系,以及乳汁、唾液HBV-DNA阳性率与血清HBV-DNA载量的相关性。结果:实验组中血清大三阳组,乳汁和唾液中HBsAg阳性率和HBV-DNA阳性率均明显高于小三阳组、单纯阳性组及对照组,两两比较差异均有高度统计学意义(P<0.01);实验组唾液HBsAg总阳性率与HBV-DNA总阳性率均高于乳汁(P<0.01);乳汁和唾液HBV-DNA阳性率与血清HBV-DNA载量呈正相关(r=0.976,P<0.01;r=0.999,P<0.01)。结论:血清大三阳产妇传染性较强;HBV携带产妇的唾液较乳汁更具有传染性;随着血清HBV-DNA载量的增加,乳汁、唾液中HBV-DNA阳性率增加,传染性增强。     

乙肝疫苗联合乙肝免疫球蛋白预防HBeAg阴性的HBV感染母亲母婴传播的效果评估

目的:评价乙型肝炎(简称乙肝)疫苗联合乙肝免疫球蛋白(HBIG)常规免疫预防措施在阻断HBeAg阴性的乙肝病毒(HBV)感染母亲母婴传播的临床效果,观察分娩方式和喂养方式对HBV母婴传播的影响。方法:对2004年1月至2012年3月在本院分娩的231例HBsAg阳性但HBeAg阴性母亲及其252例儿童随访,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,并采血检测相关指标;199例儿童曾检测脐血HBV标志物。结果:16.08%儿童脐血HBsAg阳性,但所有252例儿童随访时(3.3±2.3岁)HBsAg和抗-HBc均阴性,抗-HBs阳性率74.21%。孕期使用HBIG和未使用HBIG母亲的子女抗-HBs阳性率分别为65.22%和73.33%(χ2=1.797,P>0.05)。剖宫产组和自然分娩组母亲的儿童抗-HBs阳性率分别为76.85%和72.22%(χ2=0.69,P>0.05)。111例儿童为母乳喂养,65例人工喂养,76例混合喂养,抗-HBs阳性率分别68.47%、78.46%和78.95%(χ2=3.417,P>0.05)。结论:HBsAg阳性但HBeAg阴性孕妇的子女经正规免疫预防后,几乎无HBV感染;脐血HBsAg阳性不能确定母婴感染;孕妇孕晚期使用HBIG、分娩和喂养方式对HBV母婴传播和新生儿对乙肝疫苗的抗体应答无影响。     

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。     

孕妇乙型肝炎病毒携带状态与母婴传播的研究

目的 :探讨孕妇乙型肝炎 (乙肝 )病毒 (HBV)携带状态与母婴传播的关系。方法 :用荧光定量PCR法检测HBV表面抗原 (HBsAg)阳性孕妇血清中HBV脱氧核糖核酸(HBVDNA)及脐血HBVDNA ,婴儿出生后 1 2h内及第 1 4天注射乙肝免疫球蛋白 ,并按0、1、6的程序全程接种乙肝疫苗 ,进行前瞻性随访研究 ,分别于婴儿 7月及 1 2月时随访 ,检测HBVDNA及乙肝血清标志物 ,婴儿 7月时未感染乙肝但抗 HBs阴性者加强注射乙肝疫苗 5μg。 结果 :HBsAg、HBeAg及抗 HBc阳性孕妇的新生儿脐血HBVDNA阳性率为1 8.37% (9/ 4 9) ;HBsAg及HBeAg双阳性者为 1 2 .50 % (2 / 1 6) ;HBsAg及抗 HBc阳性者为1 2 .50 % (3/ 2 4 ) ;HBsAg,抗 HBe和抗 HBc阳性者为 1 .37% (1 / 73) ;脐血HBVDNA阳性的新生儿均生于HBVDNA阳性的母亲 ,阳性率为 1 8.52 % (1 5/ 81 ) ,不同HBV携带状态的脐血阳性率有统计学差异。总母婴传播率为 9.78%。结论 :孕妇HBV携带状态与母婴传播有关 ,孕妇血清HBeAg阳性或HBVDNA含量高是母婴传播的重要因素之一 ,孕妇血清HBVDNA阴性者母婴垂直传播的风险极小。在新生儿、婴儿接受被动及主动全程联合免疫的条件下 ,产时、产后HBV的母婴传播可以预防     

一项关于慢性乙型病毒性肝炎产妇HBV病毒载量与母乳喂养后婴儿乙肝五项的回顾性研究

目的 分析慢性乙型病毒性肝炎（CHB）产妇乙型肝炎病毒（HBV）病毒载量及母乳喂养后婴儿乙肝五项情况。方法 回顾性分析本院住院分娩的CHB产妇80例及其出生婴儿的临床资料,分析产妇分娩前血清HBV DNA载量与婴儿满6个月时乙肝五项情况。结果 80例产妇中,有41例（51.25%）HBV DNA阴性,39例（48.75%）HBV DNA阳性,其中HBV DNA低载量产妇有30例（37.50%）,HBV DNA高载量产妇有9例（11.25%）;80例出生婴儿中,有75例（93.75%）HBsAb阳性,1例（1.25%）HBsAg阳性,2例（2.50%）HBsAg+HBeAg+HBcAb阳性,2例（2.50%）五项全阴性。产妇HBVDNA阴性时,其出生婴儿的HBVM表现模式均为五项全阴性;产妇HBVDNA低载量与HBsAb阳性、HBsAg阳性、HBsAg+HBeAg+HBcAb阳性等模式有关;产妇HBVDNA高载量与HBsAb阳性和HBsAg+HBeAg+HBcAb阳性模式有关。在低载量HBV DNA阳性产妇中,有93.33%(28/30)出生婴儿呈HBsAb阳性;高载量HBV DNA阳性...     

延迟结扎脐带对HBsAg阳性产妇母婴阻断效果及婴儿免疫应答影响的前瞻性队列研究

目的探讨HBsAg阳性产妇分娩时行延迟结扎脐带对HBV母婴阻断效果及婴儿免疫应答的影响。方法收集2017年3月至2018年9月本院产检分娩的HBsAg阳性孕妇1 200例,单双数编号,单数孕妇分娩时若母婴状况稳定则施行延迟结扎脐带(新生儿出生后1～3 min),新生儿纳入晚断脐组;双数孕妇分娩时于新生儿娩出后立刻结扎脐带,新生儿纳入对照组。全部婴儿接受HBV联合免疫,即:出生时及出生后第21天肌内注射乙型肝炎免疫球蛋白100 IU,出生时及第1、6个月接种重组酵母乙型肝炎疫苗10μg。出生时查乙肝五项及HBV-DNA,婴儿7～9个月复查乙肝五项,必要时查HBV-DNA。结果联合免疫后,晚断脐组559例(95.1%)、对照组548例(89.8%)婴儿完成7～9个月随访。晚断脐组母婴阻断成功率100%;对照组母婴阻断成功率99.82%(1/548),两组比较,差异无统计学意义(P=0.495)。晚断脐组与对照组婴儿Anti-HBs1 000 IU/ml的比例(73.2%,68.4%;P=0.083)、免疫低/无应答的比例(4.5%,5.8%;P=0.303)比较,差异均无统计学意义。晚断脐组36例、对照组29例婴儿的母亲产前HBV-DNA106IU/ml,其母婴阻断成功率、Anti-HBs1 000 IU/ml的比例、免疫低/无应答的比例(100%,96.6%,P=0.446;63.9%,65.5%,P=0.891;8.3%,10.3%,P=1)比较,差异均无统计学意义。结论延迟结扎脐带不增加HBsAg阳性产妇HBV母婴传播的风险,不影响婴儿联合免疫应答。在HBsAg阳性产妇的第三产程行延迟结扎脐带是可行的。     

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。     

Risk of hepatitis B transmission in breast-fed infants of chronic hepatitis B carriers

OBJECTIVE: To measure the rate of hepatitis B (HBV) transmission from chronic HBV carriers to breast-fed infants after immunoprophylaxis. METHODS: Since 1992, information on women with HBV during pregnancy has been collected in a prospective longitudinal study. Those HBV carriers and their infants participating in a county HBV immunoprophylaxis program were identified. Infants were followed for up to 15 months and examined for hepatitis B infection by hepatitis B surface antigen (HBsAg). RESULTS: A total of 369 infants born to women with chronic HBV met the inclusion criteria and received hepatitis B immune globulin at birth and the full course of the hepatitis B vaccine series. We compared 101 breast-fed infants with 268 formula-fed infants. There was no significant difference between the two groups with respect to the number of women who were positive for hepatitis B e antigen (HBeAg) (22% versus 26%, P =.51). Three women in the breast-feeding group had liver transaminase abnormalities, compared with six women in the formula-feeding group (P =.29). Overall, there were nine cases of HBV infection transmission (2.4%). None of the 101 breast-fed infants and nine formula-fed infants (3%) were positive for HBsAg after the initial vaccination series (P =.063). The mean length of time for breast-feeding was 4.9 months (range 2 weeks to 1 year). CONCLUSION: With appropriate immunoprophylaxis, including hepatitis B immune globulin and hepatitis B vaccine, breast-feeding of infants of chronic HBV carriers poses no additional risk for the transmission of the hepatitis B virus.     

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.     

乙型肝炎病毒的母婴阻断977例1年随访研究

目的　探讨对乙型肝炎表面抗原 (HBsAg)阳性母亲分娩新生儿实施母婴阻断的最佳方案 ,探索免疫失败的原因及对策。方法　通过总结东南大学医学院附属南京第二医院 1985～ 2 0 0 3年 32 0 0例HBsAg阳性母亲分娩新生儿实施母婴阻断后的血清乙型肝炎病毒 (HBV)标志物资料 ,根据不同阻断方案分成 5组 :血源疫苗组(第 1组 )、血源联合组 (第 2组 )、基因疫苗组 (第 3组 )、基因联合组 (第 4组 )和宫内阻断组 (第 5组 )。其中共 977例婴儿随访至 12个月龄。观察、比较各组婴儿出生时及 1、6、12个月龄时的HBsAg、乙型肝炎表面抗体 (HBsAb)的阳性率。结果　第 5组 12个月龄时HBsAg阳性率仅为 4 0 % ,保护率达 96 0 % ,与前 4组比较差异有显著性意义 (P <0 0 5或P <0 0 1)。第 4、5组比较 ,出生时HBsAb检出率分别为 8 3%、81 0 % ,差异有显著性意义(P <0 0 1) ;宫内感染率分别为 5 1 7%、32 0 % ,差异有显著性意义 (P <0 0 5 ) ;免疫失败率为 19 4 %、12 5 % ,差异有显著性意义 (P <0 0 5 )。第 2、4组 12个月龄时HBsAg的阳性率分别低于第 1、3组 ,HBsAb阳性率高于第 1、3组 ,差异有显著性意义 (P <0 0 5 )。双阳组、单阳组母亲分娩新生儿 12个月龄时HBsAg的阳性率分别为2 0 1%、7 8% ,差异有显著性意     

乙肝病毒表面抗原阳性孕妇分娩新生儿乙肝病毒标志的临床意义

目的探讨乙肝病毒表面抗原(HBsAg)阳性孕妇分娩新生儿乙肝病毒标志的临床意义。 方法对1999-07—2002-06北京地坛医院儿科996例新生儿生后第3天检测静脉血乙肝病毒标志，追踪观察199例成长到3个月至4岁，将乙肝病毒标志HBsAg和HBeAg进行分析。 结果新生儿生后第3天HBsAg和HBeAg阳性率分别为27.2%(271/996)、48.1%(479/996)，有495例检测抗-HBc，阳性率高达99.2%(491/495)。在生后3个月至4岁间复测乙肝病毒标志199例，有17例感染乙肝病毒，占8.5%(17/199)。分别比较生后第3天血清HBsAg、HBeAg滴度，感染乙肝病毒新生儿的HBsAg滴度高于未感染新生儿(P<0.01)，而HBeAg滴度水平差异不明显(P>0.05)。将感染、未感染乙肝病毒儿童复查结果与生后第3天血清HBsAg、HBeAg滴度分别进行比较，17例感染乙肝病毒儿童血清HBsAg和HBeAg滴度明显升高(P<0.001，P<0.05)，而182例未感染儿童明显减低(P<0.001)。 结论HBsAg阳性孕妇分娩新生儿血清HBsAg、HBeAg和抗-HBc阳性不能作为诊断感染乙肝病毒的依据，新生儿血清HBsAg滴度较高并在生后3个月逐渐升高，可以作为儿童感染乙肝病毒的诊断依据。     

Risk of perinatal transmission of hepatitis B virus in Jordan

OBJECTIVES: To determine the risk of perinatal transmission of hepatitis B virus (HBV) in Jordan. METHODS: Plasma samples from 1000 pregnant Jordanian women were screened by ELISA for HBV markers (HBsAg, HBeAg, anti-HBe, anti-HBc and anti-HBs). RESULTS: HBsAg and HBeAg were detected in 4.3% and 0.1% of the pregnant women, respectively. The overall prevalence of antibodies was 6%, 11.1% and 7.5% for anti-HBe, anti-HBc and anti-HBs, respectively. Women were assigned to four groups according to the serological patterns of HBV markers: susceptible (85.9%), with acute infection (2.9%), with chronic infection (1.4%) and previously infected (9.8%). Most women were at the third trimester of pregnancy, therefore women with acute and chronic hepatitis at this gestational age were at risk of transmitting HBV infection to their newborns. Women who belonged to the low socio-economic class were at higher risk of HBV infection. CONCLUSIONS: Based on the results, we recommend screening women for HBV during pregnancy in order to identify HBV carriers. All newborns born to carriers should be vaccinated immediately after birth, both passively and actively. Also vaccination of HBV seronegative pregnant women is recommended.     

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.