阻断乙型肝炎病毒母婴传播方案探讨

目的探讨阻断乙型肝炎病毒母婴传播的有效方法。方法将乙型肝炎病毒携带孕妇,根据她们的不同情况和就诊的不同时期分为6组,Ms组为乙肝表面抗原阳性乙肝e抗原阴性的孕妇,根据就诊的不同时期分为Ms1组、Ms2组、Ms3组。Mse组为乙肝表面抗原和乙肝e抗原双阳性孕妇。MF组为孕妇与配偶均为乙型肝炎病毒携带者。F组为孕妇为非乙型肝炎病毒携带者配偶为乙型肝炎病毒携带者的孕妇。各组采用不同的方法阻断乙型肝炎病毒的垂直传播。结果 Ms1组230例中有22例母亲孕期用过乙肝免疫球蛋白（占本组总数9.6%）。Ms2组：372例中有37例母亲孕期用过乙肝免疫球蛋白（占本组总数9.9%）。Ms3组287例中有4例母亲孕期检测乙型肝炎病毒脱氧核糖核酸阳性用过HBIG（占本组总数1.4%）,与Ms1组和Ms2组母亲用乙肝免疫球蛋白率9.6%和9.9%比较经统计学处理差异都非常显著（χ2=17.850,P=0.000）;（χ2=20.311,P=0.000）。Mse组32例母亲在孕期都用过乙肝免疫球蛋白（占本组总数100%）。MF组72例中有20例母亲在孕期用过乙肝免疫球蛋白（占本组总数27.7%）。F组：48例中3例母亲在孕期用过乙肝免疫球蛋白（占本组总数6.2%）;32例母亲在孕期用过乙肝疫苗接种（占本组总数66.6%）。各组共1041例新生儿生后24h内静脉血乙肝抗原抗体定性检测：乙肝表面抗原和乙肝e抗原均为阴性。生后3个月至1岁随访检测婴儿静脉血1041例乙肝抗原定性乙肝表面抗原和乙肝e抗原仍均为阴性。结论孕妇或配偶为乙型肝炎病毒携带者,如乙肝e抗原阳性或乙型肝炎病毒脱氧核糖核酸阳性孕妇孕期需要注射乙肝免疫球蛋白阻断乙型肝炎病毒传播,否则不需要。父母为乙型肝炎病毒携带者,如新生儿生后检测乙型肝炎病毒抗原检测阳性需要注射乙肝免疫球蛋白,否则不需要。所有新生儿必须接种乙肝疫苗。

A study of interrupting the hepatitis B virus from mother to infant transmission

Objective：To study effective method of interrupting the hepatitis B virus （HBV） from mother to infant transmission.Methods：According their difference what the virus antigen carrying,the pregnant women who was the HBV carrier were divided six groups.Ms group＇ pregnant women were the HBV superficial antigen （HBsAg） positive and the hepatitis B e antigen （HBeAg） negative.According pregnant different years,they were divided Ms1group and Ms2group and Ms3group.Mse group＇ pregnant women were HBsAg and HBeAg double positive.MF group＇ pregnant women were the HBV carrier and their consorts were HBV carrier too.F group＇ pregnant women were not the HBV carrier but their consorts were the hepatitis B carrier.Each group＇ pregnant were adopted different method interrupting the HBV vertical transmission.Results：In Ms1 group 230 pregnant women there were 22 cases who was inject the hepatitis B immunity globulin （HBIG） during pregnant later period （9.6%）.In Ms2 group 372 prenant women there were 37casas were injected HBIG （9.9%）.In Ms3 group 287pregant women there 4 cases who was the hepatitis B deoxyribonucleic acid （HBV-DNA） positive and was injected HBIG （1.4%）.Between Ms3 group with Ms1 group and Ms2 group there were very marked difference in the pregnant women were injected HBIG percentage （χ2=17.850,P=0.000） ;（χ2=20.311,P=0.000）.In Mse group 32 pregnant women were injected HBIG all （100%）.In MF group 72 pregnant women there were 20cases were injected HBIG （27.7%）.In F group 48 pregnant women there 3 cases were injected HBIG （6.2%） and 32cases were inoculated the hepatitis B vaccine （66.6%）.Each group 1041 neonate＇s vein blood the hepatitis B antigen were negative within 24 hour after birth.Between 3 month to 1 year after birth all baby＇ vein blood the hepatitis B antigen were still negative.Conclusion：When the pregnant women or whose husband was the hepatitis B carrier,if their HBeAg was positive or HBV-DNA was positive,the pregnant women need to be injected HBIG at pregnant late time to interrupting the virus vertical transmission.Otherwise,do not need to.When parents were the HBV carrier,if the newborn vein blood the hepatitis B antigen was positive,the neonate need to be injected HBIG,otherwise,do not need to.All neonate must be inoculated the hepatitis B vaccine.