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。     

Risk of hepatitis B transmission after amniocentesis in chronic hepatitis B carriers

OBJECTIVE: To measure the risk of perinatal transmission of HBV in chronic carriers who undergo amniocentesis. METHODS: This was a prospective, longitudinal study from 1990 to 1995 of women who were HBV carriers and underwent amniocentesis. The infants of these women were followed from birth to one year of age. Maternal data examined included HBV antigen and antibody status, liver function tests (LFTs) and the amniocentesis report. RESULTS: Twenty-eight women were identified. Two of 28 neonates were stillborn unrelated to hepatitis. Five infants were lost to follow-up leaving 21 mother-child pairs to evaluate. All 21 women were chronic HBV carriers at the time of amniocentesis for delivery. No mother had abnormal LFTs, and only one of 21 women was positive for hepatitis B e antigen (HBeAg). Thirteen amniocenteses were for advanced maternal age, and four were for abnormal maternal serum alphafetoprotein (MSAFP) screening. None of the amniocenteses were recorded as bloody, and the placenta was anterior in 6 of 21 procedures. None of the 21 infants (95% CI: 0-16.8%) were positive for HbsAg during the first month of life or at 12 months of age. All infants received HBV vaccine and HBIG immunoprophylaxis. CONCLUSION: The risk of transmission of HBV to the fetus after amniocentesis in women who are HBV carriers is low. Immunoprophylaxis in these infants was successful.     

妊娠合并乙型肝炎病毒感染围分娩期管理

对乙型肝炎(乙肝)病毒感染孕妇采取合理的围分娩期管理以阻断母婴垂直传播是降低我国慢性乙肝感染率的关键。新生儿出生后及时注射乙肝免疫球蛋白,并按照0、1、6方案接种乙肝疫苗,可有效阻断乙肝的围分娩期传播。孕妇在晚孕期进行抗病毒治疗可能通过降低母体病毒水平而减少围分娩期传播风险,但抗病毒药物对胎儿的安全性仍需进一步验证。     

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。     

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。     

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.     

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。     

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.     

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.     

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).     

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.     

Assessing perinatal hepatitis B screening and neonatal prophylaxis in a large, multiethnic county

OBJECTIVE: To assess the completeness of maternal screening and appropriateness of newborn prophylaxis for hepatitis B virus (HBV) in 2001 in Florida's largest county. STUDY DESIGN: A retrospective cohort study sampled 1% of deliveries at all hospitals in Miami-Dade County that had delivery suites. Abstractors reviewed mothers' and newborns' charts before discharge to determine whether newborns received appropriate HBV prophylaxis based on mothers' hepatitis B virus surface antigen (HBsAg) status at 12 hours postpartum. At each hospital, deliveries were sampled sequentially until the target number was reached. Sampling was donefor March-August 2001. RESULTS: Among 339 deliveries at 14 hospitals, the mother's HBsAg status was known within 12 hours of delivery for 286, or 84.4% (95% CI 80.1-88.1%). Of the 53 infants whose mothers' HBsAg status was unknown, 15 (28.3%) were vaccinated within 12 hours of delivery; both infants whose mothers were HBsAg positive received vaccine and immune globulin within 12 hours delivery. CONCLUSION: While HBsAg screening of pregnant women is widespread in Miami-Dade County, the information is not consistent used to protect infants who mothers' HBsAg status unknown.     

Chronic hepatitis B infection and pregnancy

It is estimated that 350 to 400 million individuals worldwide are chronically infected with hepatitis B virus (HBV). In regions of high endemicity, many of these are females of reproductive age who are an important source for perinatal transmission. There are a number of issues specific to the women of childbearing age who have chronic HBV infection, including the safety of antiviral therapy during pregnancy and breast-feeding, the changes in the immune system during pregnancy and postpartum that may impact on the natural history of HBV, and the emerging role of antivirals to reduce perinatal transmission of HBV. For women in their reproductive years who require treatment, many of the available antivirals have not been studied in pregnant or breast-feeding women and their use requires the development of a carefully considered strategy, considering the impact of both the disease and treatment on the mother and fetus/infant. The purpose of this article is to (1) review data regarding the mechanisms and timing of perinatal HBV infection; (2) review data on interventions, particularly antiviral therapy, to reduce perinatal transmission beyond the protection afforded by hepatitis B immunoglobulin and vaccination; (3) summarize the immunological changes associated with pregnancy and the potential effect these may have on the natural history of HBV infection; and (4) summarize the information currently available for antiviral therapy available for HBV treatment, focusing specifically on safety data pertaining to reproduction, pregnancy, and breast-feeding. TARGET AUDIENCE: Obstetricians & Gynecologists and Family Physicians. LEARNING OBJECTIVES: After completing this CME activity physicians should be better able to classify the interventions to reduce mother-to-child transmission of hepatitis B including antivirals, caesarean section, hepatitis B immunoglobulin and hepatitis B vaccine, assess the immunological changes associated with pregnancy and the potential effect this may have on the natural history of HBV infection and apply the information currently available for antiviral therapy licensed for HBV treatment, focusing specifically on safety data in pregnancy and during breastfeeding.     

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.     

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。     

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     

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。     

子宫内乙型肝炎病毒感染对新生儿免疫接种的影响

目的　探讨乙型肝炎病毒 (HBV)侵犯新生儿外周血单个核细胞 (PBMC) ,对新生儿免疫接种的影响 ,并从白细胞介素 2 (IL 2 )水平变化分析其可能的机理。方法　对 5 2例乙型肝炎表面抗原 (HBsAg)阳性孕妇分娩的新生儿行乙型肝炎免疫球蛋白和乙型肝炎疫苗 (HBVac)联合免疫接种 ,7个月时进行随访。用巢式聚合酶链反应 (nested PCR)技术检测新生儿血清和PBMC中HBVDNA ,固相放射免疫法检测血清乙型肝炎表面抗体 (HBsAb) ,采用体外细胞培养和双抗体夹心酶联免疫法检测PBMC在植物血凝素 (PHA)和HBsAg刺激下 ,培养上清液中IL 2的含量。结果　HBV侵犯PBMC后 ,新生儿免疫接种的失败率为 73 3% ,显著高于PBMC未受侵犯新生儿的 5 4 % ,差异有显著性 (P<0 0 5 ) ;免疫接种失败新生儿的PBMC培养上清液中 ,IL 2含量为 (85± 37)ng/L(PHA刺激 )、(5 1±18)ng/L(HBsAg刺激 ) ,明显低于免疫接种成功者和正常对照 ,差异均有显著性 (P值均 <0 0 5 )。结论　宫内感染HBV并侵犯PBMC ,是新生儿免疫接种失败的重要原因 ;HBV侵犯PBMC可使其IL 2分泌能力下降 ,可能是导致新生儿免疫接种失败的原因之一     

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