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。     

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。     

联合免疫后乙肝病毒携带产妇母乳喂养安全性的探讨

目的:探讨主被动联合免疫后乙肝病毒(HBV)携带产妇的婴儿接受母乳喂养的安全性。方法:前瞻性追踪115例孕晚期注射高效价乙肝免疫球蛋白(HB IG)的HBV携带产妇乳汁中HBV感染性标志物(HBVM)、HBV-DNA和新生儿外周血HBVM情况,以及接受联合免疫后母乳或人工喂养7月龄婴儿血HBVM情况。其中母乳喂养组婴儿70例,人工喂养组45例。结果:2组新生儿HBV感染率分别为11.4%和13.3%,2组婴儿母亲外周血HBeAg阳性率分别为31.4%和31.1%,差异均无统计学意义。母乳喂养组和人工喂养组产妇初乳中HBsAg阳性率分别为34.3%和40.0%,HBeAg阳性率分别为28.6%和26.7%,2组产妇初乳中HBsAg阳性率、HBeAg阳性率和HBV-DNA滴度比较,差异均无统计学意义。母乳喂养组和人工喂养组7月龄婴儿HBV感染率分别为5.7%和8.9%,抗HBs阳性率分别为85.7%和84.4%,2组比较差异均无统计学意义。结论:在进行多重联合免疫干预后,HBV携带产妇母乳喂养并不增加HBV母婴传播的风险。     

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.     

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。     

酵母重组基因工程乙型肝炎疫苗与血源疫苗对新生儿的保护作？…

目的 评价酵母重组基因工程乙型肝炎（乙肝）疫苗对乙肝表面抗原（ＨＢｓＡｇ）及ｅ抗原阳性（双阳）母亲分娩的新生儿的保护效果及副反应,并与血源乙肝疫苗比较。方法 将１１７例双阳母亲分娩的新生儿,分为试验组７６例,注射酵母重组基因工程乙肝疫苗５μｇ,对照组４１注射血源乙肝疫苗３０Ｕ,均于出生后２４小时、１个月、６个月注射,每次注射前扩及出生９个月时抽取静脉血,检查乙肝病毒脱氧核糖核酸片段（ＨＢＶ－ＤＮＡ     

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     

外周血单个核细胞在乙型肝炎病毒母婴传播中的作用研究

目的 探讨外周血单个核细胞(PBMC)在乙型肝炎病毒(HBV)母婴传播中的作用及在早期诊断宫内感染的价值。方法 120例经ELISA法确定为乙型肝炎表面抗原(HBsAg)阳性的孕妇为研究组,其中60例为HBsAg和乙型肝炎e抗原(HBeAg)双阳性,定为双阳组;60例仅为HBsAg阳性,定为单阳组。30例非HBV携带的孕妇为对照组。应用PCR法检测母婴血清及PBMC中HBV-DNA。结果 双阳组中,血清HBV-DNA检出率为25.0％(15/60),脐血PBMC中HBV-DNA检出率为50.0％(30/60)。母婴PBMC的HBV-DNA阳性显著相关(P<0.05);脐血血清HBV-DNA检出率与脐血PBMC中HBV-DNA检出率两者比较,具有显著性差异(P<0.001);母婴血清HBV-DNA阳性无相关性(P>0.05)。结论 被HBV感染的PBMC可通过胎盘感染胎儿,可能是HBV宫内传播的一种机制,脐血PBMC HBV-DNA阳性率明显高于脐血清,对早期诊断HBV宫内感染有一定价值;母亲传染性强是宫内感染的重要因素。     

Hepatitis B virus surface antibody titers in babies administered hepatitis B immune globulin both intravenously and intramuscularly after birth

Objective: High rates of vertical transmission of hepatitis B virus (HBV) infection from carrier mothers to their babies are observed in hepatitis B e antigen (HBeAg)-positive mothers under the existing protocol. The current status suggests that the existing protocol may be insufficient for the prevention of mother-to-child transmission (MTCT) in HBeAg-positive mothers. To achieve complete prevention of HBV vertical transmission, we designed a protocol implementing intravenous administration along with ordinary intramuscular administration of HBV immune globulin (HBIG) to the baby after birth.

Methods: We compared the HBV surface antibody (HBsAb) titer in babies who were simultaneously administered HBIG both intravenously and intramuscularly after birth with that in babies who received HBIG only intramuscularly.

Results: The HBsAb titer rose rapidly after administration in the combined administration group, and the elevated titer was maintained for approximately 2 months. Although the antibody titer at the peak was nearly 6 times greater in the combined administration group than in the intramuscular administration group, the combined administration of HBIG did not have any effect on total IgG antibody levels in the bloodstream.

Conclusion: The combined protocol was demonstrated to be safe and superior to the protocol of only intramuscular HBIG administration with respect to rapid elevation of HBsAb in the bloodstream. It could be an effective method for the prevention of MTCT in HBeAg-positive mothers.     

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。     

Amniocentesis in mothers who are hepatitis B virus carriers does not expose the infant to an increased risk of hepatitis B virus infection

Sixty-seven pairs of mothers with hepatitis B virus (HBV) surface antigen (HBsAg) and their infants were divided into two study groups to determine the effect of amniocentesis on intrauterine HBV infection. In the first study group (35 pairs), the infant's HBsAg status in cord blood was studied and the results were compared with those obtained in the cord blood from 65 infants born to HBsAg-positive women who did not have an amniocentesis. In the second study group (32 pairs), the HBV status of the infants was studied at the age of three months to five years and compared with the HBV status of 3,454 infants in the National HBV Prevention Program. In the first study group, one sample (2.9%) was weakly positive for HBsAg; while in the first control group, two (3.1%) were positive. In the second study group, three (10%) infants were positive for HBsAg. The failure rates of immunoprophylaxis in the second study and control groups were similar (9.4% vs 11% for HBsAg carrier mothers; 30% vs 14% for HBe antigen-positive carrier mothers). This suggested that genetic amniocentesis did not increase the risk of intrauterine HBV infection.     

孕妇乙型肝炎病毒感染状态与胎儿宫内感染的关系

目的 :探讨孕妇乙型肝炎病毒 (HBV)感染状态与胎儿宫内感染发生率的关系。方法 :用酶联免疫吸附试验(ELISA)筛选出 79例HBV感染孕妇 ,并用荧光定量聚合酶链反应 (FQ PCR)技术检测孕妇血清及脐血中HBV DNA。结果 :4 7例大三阳孕妇血清HBV DNA检出率为 97 9% ,32例小三阳孕妇血清HBV DNA检出率为 9 4 % ,两组差异有非常显著性 (P <0 0 1)。大三阳孕妇脐血中HBV DNA检出率为 31 9% ,小三阳孕妇脐血中HBV DNA检出率为 0 % ,两组差异有非常显著性 (P <0 0 1)。结论 :胎儿宫内感染与孕妇HBV感染状态和HBV DNA检出率有关。     

Hepatitis B vaccine inhibiting vertical transmission of hepatitis B virus]

A survey of hepatitis B virus infection was carried out among 1,947 pregnant women. The results showed that 215 women were HBsAg positive, a rate of 10.7%. Among the 38 serum samples reexamined, 10 were positive both for HBsAg and HBeAg (26.3%). In order to evaluate the effect of hepatitis B vaccine on inhibiting vertical transmission, all infants of the 38 women positive for HBsAg were given hepatitis B vaccine 40 micrograms. by injection 7 months after the immunization, HBsAg was found absent in 31 of them, but all the infants had produced anti-HBsAg antibody. The positive rate of anti-HBsAg antibody in infants whose mothers had both positive HBsAg and HBeAg was 50%, whereas in infants whose mothers had only positive HBsAg it was 92.9% (chi 2 = 6.38 P less than 0.05).     

男性乙型肝炎病毒感染与IVF/ICSI妊娠结局的关系

目的:探讨男性在乙型肝炎病毒感染期及恢复期接受IVF/ICSI对妊娠结局是否造成影响。方法:回顾性分析首次接受IVF/ICSI治疗的496对不孕夫妇,术前进行血清HBV及乙肝5项检测,女方乙肝5项均为阴性或仅HbsAb阳性且HBV-DNA阴性。根据男方乙肝检查结果分成3组,A组(297对夫妇):男方乙肝5项均为阴性或仅HbsAb阳性且HBV-DNA阴性;B组(81对夫妇):男方乙肝大三阳且HBV-DNA阳性;C组(118对夫妇):男方乙肝小三阳且HBV-DNA阴性。统计分析3组第1次新鲜周期治疗情况及妊娠结局,并进一步比较3组中行ICSI周期的临床结局。结果:在IVF/ICSI周期中A、B、C组女方的临床妊娠率(40.1%vs47.9%vs 36.7%)、早期流产率(8.3%vs 8.6%vs 2.5%)无统计学差异;早产率、抱婴回家率(34.2%vs 42.5%vs 33.9%)和婴儿出生情况各组间亦相似。在ICSI周期中,3组的临床妊娠率、早期流产率、抱婴回家率及婴儿出生情况亦无统计学差异(P>0.05)。结论:男性在乙肝病毒感染期和恢复期无论采用IVF或ICSI方式授精,对妊娠结局及婴儿出生情况均无不良影响。     

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.     

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     

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.     

Risk factors for intrauterine infection with hepatitis B virus

Objective

To investigate risk factors for hepatitis B virus (HBV) intrauterine infection.

Methods

Peripheral blood samples and clinical data were collected from 174 pregnant women who were positive for hepatitis B surface antigen (HBsAg). Their 176 neonates received an active–passive immunization schedule at 0, 1, and 6 months. Blood samples from the infants, collected before immune prophylaxis administration, were tested for HBV markers and HBV DNA.

Results

The intrauterine infection rate at 6 months after birth was 5.1%. Maternal HBV DNA positivity (OR 11.362; 95% CI, 1.389–92.931), hepatitis B e antigen (HBeAg) positivity (OR 7.278; 95% CI, 1.734–30.538), and thalassemia minor (OR 15.619; 95% CI, 2.239–108.964) were associated with intrauterine infection. The intrauterine infection rate for mothers with 10⁵ copies/mL of serum HBV DNA or more was 18.2%, compared with 0.8% for mothers with less than 10⁵ copies/mL.

Conclusion

A positive HBsAg test at 24 hours and/or 1 month of age followed by a positive test at 6 months is an objective and comprehensive criterion for the diagnosis of HBV intrauterine infection. Maternal HBV DNA positivity (especially 10⁵ copies/mL of HBV DNA or more), HBeAg positivity, and thalassemia minor are risk factors for HBV intrauterine infection.     

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。     

131例乙肝孕妇行介入性产前诊断的垂直传播风险分析

目的了解行介入性诊断的乙肝孕妇发生垂直传播的风险情况。方法回顾性分析2017年7月至2018年6月间来广东省妇幼保健院产前诊断科行介入性产前诊断、符合纳入标准的乙肝表面抗原(HBsAg)阳性孕妇及其所生婴儿的临床资料,总结不同穿刺类型、不同穿刺指征、是否合并乙肝e抗原(HBeAg)阳性等情况下的母婴垂直传播风险。结果本研究共纳入131例(含双胎5例)乙肝孕妇和136例所生婴儿,共3例(2.21%)在乙肝联合免疫后依然被检出感染乙肝;HBeAg阴性和HBeAg阳性孕妇所生婴儿发生感染的几率分别为1.09%(1/92)和5.71%(2/35);乙肝病毒DNA定量超过106IU/ml和107IU/ml的垂直传播率分别为4.35%(1/23)和5.00%(1/20);行羊膜腔穿刺术、脐静脉穿刺术和绒毛吸取术的乙肝孕妇发生垂直传播的几率分别为1.11%(1/90)、2.56%(1/39)和14.29%(1/7);因超声异常表现和其他非超声异常指征行介入性产前诊断孕妇发生垂直传播的风险分别为2.82%(2/71)和1.54%(1/65);10例孕妇孕期接受了抗病毒治疗,该10例所生婴儿均未发生感染。结论乙肝孕妇行介入性产前诊断有发生母婴垂直传播的风险,仍需大样本研究进一步探讨。