HBIG阻断HBV母婴垂直传播的疗效观察

目的：观察评价外源性注射HBIG对HBV母婴垂直传播的阻断效果和安全性。方法：选取2006年7月2007年7月在我院产前检查和分娩的阳性孕妇200例作为对象。根据知情同意原则,分为三组,HBIG 1组：同意孕期及产后注射HBIG者75例;HBIG 2组,同意产后注射HBIG者85例;非HBIG组不同意或因经济原因无法注射HBIG者40例。凡新生儿HBV-DNA（＋）,即表示胎儿宫内感染HBV;婴儿出生后6个月HBV-DNA（＋）,亦表示母婴垂直传播HBV。结果：孕28周时孕妇乙肝标志物各指标检测结果三组间比较,差异无统计学意义（P〉0.05）,而HBIG1组经过产前3次HBIG注射之后,HBsAg、HBeAg、HBsAb阳性率与HBIG2组和非HBIG组间比较,有显著性差异（P〈0.01,P〈0.05）。三组孕妇在孕28周和产前血清中的HBV-DNA阳性率间比较,差异无统计学意义（P〉0.05）;三组产后乳汁中HBV-DNA阳性率间比较,差异有统计学意义（P〈0.05,P〈0.01）。新生儿和6个月婴儿HBV感染率HBIG 1组〈HBIG 2组〈非HBIG组（P〈0.05,P〈0.01）。结论：肌注HBIG可对HBV母婴垂直传播的阻断效果明显,并可降低母乳喂养感染的风险,且孕晚期孕妇和新生儿均使用HBIG优于仅产后新生儿肌注。孕晚期孕妇肌注HBIG可降低HBV的传染力。

Therapeutic Efficacy of Hepatitis B Immunoglobulin(HBIG)on Blocking Mother-Fetal Transmission of Hepatitis B in HBsAg Positive Pregnant Women

Objective To investigte the therapeutic efficacy and safcty of exogenous HBIG administration on blocking mother-fetal transmission of hepatitis B in pregnant women.Methods Altogether 200 HBsAg positive pregnant women participated in this study.① 75 pregnant women were given i.m.HBIG 200IU at 28,32,and 36 wk gestation as well as within 24h after delivery.The neonates were also given i.m.HBIG 200IU within 24h after delivery and rountinely vaccinated with HBV vaccine.② 85 pregnant women and their neonates received i.m.HBIG 200IU only once within 24h after delivery with routine HBV vaccination for the neonates.③ 40 pregnant women and their neonates received no HBIG but the neonates were routinely vaccinated.Serum HBV markers（with ELISA） and HBV-DNA copies（with PCR） were determined in all the pregnant women at 28 wk gestation and beofre labor.Serum HBV-DNA copies were determined in all the neonates and 6 months later.Milk HBV-DNA copies were also determined.Results At 28 wk gestation,the serum HBV markers and HBV-DNA copies contents in these 3 groups of pregnant women were about the same.After three doses of HBIG,the serum HBsAg and HBeAg contents were significantly lower than those in pregnant women without HBIG,while the HBsAb contents were significantly higher（P〈0.05 or P〈0.01）,and the HBV-DNA copy numbers were not much changed.The most significant result after HBIG administration was a significantly lower milk HBV-DNA positive rate（9.33%） than those in the two other groups（17.64% and 30.00% respectively,P〈0.05 and P〈0.01）.At the same time,the serum HBV-DNA psotive rate in the neonates of the pregnant women with HBIG injection during gestation was significantly lower than that in neonates of the other two groups（P〈0.05 and P〈0.01）.The same was true six months later.Conclusion HBIG administration during late pregnancy could substantially reduce the rate of maternal-fetus transmission of hepatitis B in HBsAg positive pregnant women.