孕晚期肌肉注射HBIG与新生儿及产后乳汁HBV-DNA含量相关性分析

目的通过对孕产妇各个时期注射高效价乙肝免疫球蛋白(HBIG)后血清及乳汁中HBV DNA含量的分析、比较,为乙肝携带者孕产妇的乙肝病毒的母婴阻断及产后母乳喂养方案提供实验依据。方法选取2012年6月至2014年6月在该院产科门诊进行产前检查HBsAg(+)的乙肝携带者孕妇140例,根据自愿、保密的原则,分为研究组和对照组,其中研究组75例于孕期28、32、36周进行肌注高效价HBIG 200U,对照组65例中的孕产妇由于各种原因在孕期未进行HBIG注射。分别于注射前、分娩前检测两组血清中HBV DNA含量、分娩后对新生儿血清及3~5d内乳汁进行HBV DNA含量检测,分析两组的差异及相关性。结果注射HBIG前研究组HBV DNA含量500copies/mL、500~(-1)×10~6copies/mL、1×10~6 copies/mL分别为:28例、17例、30例,产前分别为:35例、20例、20例;对照组产前2次检测为:19例、21例、25例及20例、17例、28例;在研究组与对照组中新生儿血清HBV DNA阳性分别为:1例(5.3%)及5例(7.7%);在两组乳汁中HBV DNA阳性分别为:3例(4%)和8例(12.3%)。结论乙肝携带者孕妇在孕晚期进行HBIG的注射可能影响其乙肝病毒的复制进而减少新生儿宫内感染的概率,同时降低其产后乳汁的HBV DNA的阳性率。

Analysis on correlation between intramuscular HBIG in late pregnancy with neonatal and postnatal milk HBV DNA content

Objective To analyze and compare the HBV DNA contents in serum and breast milk after injection of hepatitis B im‐munoglobulin (HBIG) in different periods of pregnant and lying‐in women to provide the experimental basis for blocking the mater‐nal‐neonatal transmission(PMTCT) and breast feeding scheme .Methods 140 pregnant women carrying hepatitis B virus with HB‐sAg(+ ) by antenatal examination in the obstetric outpatient department of our hospital from June 2012 to June 2014 were selected and divided into the research group and the control group according to the voluntary and secretive principle .Among them ,75 cases in the research group were intramuscularly injected by high titer HBIG 200 U at 28 ,32 ,36 weeks of pregnancy ,while 65 cases in the control group were injected by HBIG at the end of pregnancy due to different causes .Serum HBV‐DNA content before injection and before delivery was detected in the two groups ,and which in neonatal serum and breast milk within 3-5 d also detected .The differences and correlation between the two groups were analyzed .Results The HBV‐DNA content <500 copies/mL ,500-1 × 106 copies/mL ,>1 × 106 copies/mL before HBIG injection in the research group were 28 cases ,17 cases ,30 cases respectively ,which before delivery were 35 cases ,20 cases ,20 cases respectively ;which in antenatal twice detection in the control group were 19 cases , 21 cases ,25 cases and 20 cases ,17 cases ,28 cases respectively ;neonatal serum HBV‐DNA positive in the research group and control group had 1 case(5 .3% ) and 5 cases (7 .7% ) respectively ;the breast milk HBV‐DNA positive in the two groups had 3 cases(4% )/and 8 cases(12 .3% ) respectively .Conclusion HBIG injection at late pregnancy in the pregnant women carrying HBV could influ‐ence the HBV replication ,thus reduces the probability of neonatal intrauterine infection ,at the same time reduces the HBV‐DNA positive rate of postpartum breast milk .