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     

乙型肝炎孕妇死胎胎儿肝组织中HBV的表达

探讨通过产妇传播乙型肝炎病毒在胎儿肝组织中表达的高危因素。方法：采集５０例乙型肝炎产妇娩下的死胎,常规尸检,取肝组织,用链酶卵白素－生物素（ＳＰ）法检测ＨＢＶ;与婴母产前静脉血ＨＢＶ的检测结果对照。结果：在肝细胞浆内 ＨＢｃＡｇ阳性颗粒呈弥散分布,肝细胞核不着色;含 ＨＢｃＡｇ 颗粒的肝细胞胞浆里弥漫棕黄色,成点、灶片状分布于肝组织中;毛细胆管上皮和管腔内也可见到棕黄色ＨＢｃＡｇ颗粒。５０例乙型肝炎产妇娩下的死胎肝组织中ＨＢｃＡｇ阳性２１例（４２．００％）,其中静脉血ＨＢＶ单项阳性（两时半一项阳性）、小三阳（ＨＢｓＡｇ、ＨＢｅＡｂ、ＨＢｃＡｂ皆阳性）和大三阳（ＨＢｓＡｇ、ＨＢｅＡｇ、ＨＢｃＡｂ皆阳性）的婴母分娩的死胎肝组织中 ＨＢｃＡｇ 阳性分别为 ３ ／１２例（２５．５％）、２／１２例（１６．６７％）和 １６／２６例（６１．５２％）,前两者差异不显著（Ｐ＞ ０．０５）;后者与前两者差异有显著性（Ｐ＜ ０．０５）。结论：婴母静脉血ＨＢＶ大三阳是乙型肝炎病毒通过母婴垂直传播在胎儿肝组织中表达的高危因素。     

初乳中丙型肝炎病毒标志物的测定

目的：检测乳汁中丙型肝炎病毒（ＨＣＶ）标志物，探讨丙型肝炎病毒通过母乳传播的可能性。方法：用间接酶联免疫吸附试验同时检测血清和初乳中抗ＨＣＶ－ＩｇＧ、ＩｇＡ、ＩｇＭ３类抗体；并用逆转录聚合酶链反应检测ＨＣＶＲＮＡ。结果：在血清抗ＨＣＶ－ＩｇＧ阳性的３５例产妇初乳标本中，抗ＨＣＶ－ＩｇＡ、ＩｇＧ、ＩｇＭ抗体分别检出１９例、６例及１例。ＨＣＶＲＮＡ在３５份血清中阳性检出率为４０．０％（１４／３５），而初乳中仅检出２例（５．７％；２／３５），两者之间有明显差异（Ｐ＜０．０１）。结论：血清抗ＨＣＶ－ＩｇＧ阳性产妇初乳中的抗ＨＣＶ抗体以ＩｇＡ类为主；血清中ＨＣＶＲＮＡ的检出率明显高于初乳。血清抗ＨＣＶ－ＩｇＧ阳性的产妇，尤其是初乳中抗ＨＣＶ－ＩｇＡ和ＨＣＶＲＮＡ也为阳性者，有可能通过哺乳而导致婴儿感染ＨＣＶ。     

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     

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。     

孕妇血清中乙型肝炎病毒DNA含量与胎儿宫内感染的关系

探讨孕妇血清中乙型肝炎病毒ＤＮＡ含量与胎儿宫内感染发生率的关系。方法用斑点杂交法检测１８５例乙型肝炎病毒表面抗原阳性孕妇血清中ＨＢＶＤＮＡ及新生儿ＨＢｓＡｇ。结论孕妇血清ＨＢＶＤＮＡ含量升高是胎儿发生乙型肝炎病毒感染重要因素之一。     

乙肝病毒母婴传播的可能途径研究

目的 研究乙肝病毒（ＨＢＶ）母婴之间的各种传播途径,探讨其可能的防治措施。方法 采用ＰＣＲ检测法对５６例孕妇作ＨＢＶ－ＤＮＡ检测,阳性者作为研究组,对其新生儿脐血,母乳汁,母唾液作ＨＢＶ－ＤＮＡ检测,同期５２例孕妇血清ＨＢＶ－ＤＮＡ阴性者作对照组,作同样系列ＨＢＶ－ＤＮＡ检测。结果 研究组中脐血,母乳汁,母唾液ＨＢＶ－ＤＮＡ的阳性率分别为４２．８６％,３７．５０％,１０．７１％,而对照组分别为０,     

套式聚合酶链反应检测人乳中乙型肝炎病毒DNA

套式聚合酶链反应检测人乳中乙型肝炎病毒ＤＮＡ王小青刘亦琪孙亦骏蒋涛孕妇携带乙型肝炎病毒（ＨＢＶ），除可引起围产儿死亡外，还可使婴儿感染ＨＢＶ后成为慢性携带者。乳汁中检测出ＨＢＶ－ＤＮＡ为其具有传染性最可靠的指标。我们采用套式聚合酶链反应（ｎｅｓｔｅｄ...     

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.     

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。     

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     

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。     

The maternal-infant center in the control of hepatitis B

A seroepidemiologic survey of HBV infection was carried out in four population groups served by the Maternity Hospital of Majorca, an island in the Mediterranean. The prevalence of HBV markers (HBsAg, anti-HBs, anti-HBc), determined by enzyme-immunoassay, reached 17.2% among 864 parturients, 17.2% in 783 hospital personnel, 2.7% and 19.2% among the 186 children and 73 husbands of parturients with no HBV markers, 22.8% and 43.8%, respectively, among the 44 children and 48 husbands of HBsAg chronic carrier parturients. The prevalences of HBsAg in the same groups reached 0.9%, 1.5%, 0% and 0%, 11.4% and 2.1%, respectively. The carrier state represents 50% of all infection cases among children and 4.8% among husbands of carrier women. The prevalence of markers, which was especially high among personnel working in maintenance services (39.1%), on surgical wards (35.3%), among midwives (27.6%) and in cleaning and laundry services (27.1%), and laboratories (21.4%), is used as an indicator in defining priorities for the vaccination of people at risk. Sixty-seven newborn babies of HBsAg carrier mothers were administered one dose of HBIG and three doses of hepatitis B vaccine; at 12 months of age, the seroconversion rate was 98.5%, whereas 1 child (1.5%) became a chronic carrier. Maternity hospitals represent the ideal centers in which to carry out the detection of HBsAg in pregnant women prior to parturition, to ensure that all newborns of chronic carrier women receive passive-active immunization, and to screen their family contacts and vaccinate those who are found susceptible to the infection.     

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。     

乙肝表面抗原阳性孕妇肌注乙肝免疫球蛋白预防母婴传播的临床研究

目的　探讨经母亲对胎儿行被动免疫在预防乙型肝炎病毒(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 例血清抗HBS( ) ,与B 组相比具有显著差异( P < 0-05) 。A 组新生儿血HBsAg 、HBV DNA 检出率均明显低于B 组。A 组孕妇用药后血HBsAg 滴度及HBVDNA 水平较用药前明显下降。结论　经母亲对胎儿行被动免疫可有效预防HBV 宫内感染。     

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。     

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.     

Acute hepatitis A in pregnancy: a report of 43 cases

Forty-three cases of pregnancy associated with acute hepatitis treated in our hospital from February to June 1988 were analysed. Eighteen cases got hepatitis A in the second trimester and 25 cases in the third trimester. All the patients had symptoms and signs of hepatitis, increased level of serum glutamine pyruvic transaminase and the diagnosis was confirmed by antihepatitis A virus IgM (anti HAV-IgM) assay. 1-3 of markers HBsAg, anti-HBs, HBeAg, anti-HBe and anti-HBc were positive in 31 cases, accounting for 72% of them. 23 cases (77%) were delivered vaginally and 10 cases (23%) by cesarean section. 42 newborn infants survived and one fetus died in utero. Perinatal mortality rate was 23 per thousand. 24 newborn infants were tested for anti-HAV-IgM within 24 hours after birth and 10 cases (23.8%) at the age of one month and all babies gave negative result. Our study indicated that HAV does not seem to be transmittable from mother to the newborn.