HBIG阻断乙型肝炎病毒母婴传播

目的:评价HBsAg阳性母亲孕晚期肌注HBIG(乙肝免疫球蛋白)及婴儿出生后HBIG联合乙肝疫苗对HBV母婴传播及慢性化阻断的效果. 方法:历史对照组只对婴儿进行乙肝疫苗的全程免疫;HBIG组母亲孕晚期3 mo每月肌注200 u的HBIG;婴儿出生时、半月龄时分别肌注200 u的HBIG,并常规接种乙肝疫苗. 随访两组婴儿HBsAg变化情况,采用历史对照临床试验评价母亲及新生儿注射HBIG对HBV母婴传播及慢性化的阻断效果. 结果:历史对照组HBV宫内感染率5.34%,随访时婴儿HBsAg转阳率5.15%,HBV感染慢性化率87.5%;HBIG组分别为5.26%,0,18.18%. 经统计学检验,两组HBV宫内感染率无显著差异(P=1.000),但婴儿HBsAg转阳率及HBV感染慢性化率具有显著差异(P分别为0.019, 0.001). 结论:母亲孕晚期注射HBIG对阻断HBV宫内传播效果不明显;母亲及新生儿注射HBIG可显著提高乙肝疫苗对婴儿出生后HBsAg阳转及HBV感染慢性化的阻断效果.

Effect of HBIG on blocking mother-to-infant transmission of HBV

AIM: To evaluate the blocking effect of hepatitis B immunoglobulin (HBIG) administrated to HBsAg positive pregnant women during late pregnancy and immune reagents (HBIG together with HBV vaccine) to their neonates on mother-to-infant transmission of HBV and its chronicity. METHODS: Each infant in the historical control group (n=205) was only immunized with 3 doses of plasma-derived vaccine routinely, while each pregnant woman in the HBIG group (n=213) was given 200 u HBIG intramuscularly every 4 weeks from 28th week of gestation and each of their infants was injected intramuscularly with HBIG 200 u at birth and 15 d after birth and then with 3 doses of recombinant yeast-derived hepatitis B vaccine routinely. All infants were followed up to observe the change of serum HBsAg. A historical control clinical trial was performed to evaluate the blocking effect of HBIG injected to mothers and their newborns on mother-to- infant HBV transmission and its chronicity. RESULTS: The rates of intrauterine HBV infection, seroconversion to HBsAg positivity in infants during follow-up, HBV infection chronicity were 5.34%, 5.15%, 87.5% respectively in control group, and 5.26%,0,18.18% respectively in HBIG group. The rate of intrauterine HBV infection was no significantly lower in HBIG group compared with that in control group (P=1.000). There were significant differences for the rate of seroconversion to HBsAg positivity during follow-up and HBV infection chronicity(P= 0.019, 0.001 respectively). CONCLUSION: HBIG administrated to HBsAg positive pregnant women during late pregnancy can't prevent intrauterine transmission of HBV effectively. HBIG to mothers and their neonates can improve the blocking effect of HBV vaccine effectively on the seroconversion to HBsAg positivity during follow-up and HBV infection chronicity in infants.