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免疫阻断乙型肝炎病毒母婴传播多中心研究
引用本文:张磊,桂希恩,汪波,贺兴玲,张玲,朱凤仪,李莉,叶萍,黎逢良,周云,刘小英. 免疫阻断乙型肝炎病毒母婴传播多中心研究[J]. 中国实用妇科与产科杂志, 2015, 31(1): 65-69. DOI: 10.7504/fk2014120114
作者姓名:张磊  桂希恩  汪波  贺兴玲  张玲  朱凤仪  李莉  叶萍  黎逢良  周云  刘小英
作者单位:作者单位:1.武汉大学中南医院感染科,湖北 武汉430071;
基金项目:香港择善基金(03235807)
摘    要:目的 探讨孕产妇乙型肝炎表面抗原(HBsAg)阳性率及乙型肝炎病毒(HBV)母婴传播阻断的效果。方法 2008-2012年,通过多中心队列研究,对湖北省、山西省、广东省、新疆维吾尔自治区等地的孕产妇进行HBsAg筛查;对上述地区部分医院入院分娩的HBsAg阳性母亲及8~12个月龄婴儿进行随访观察,所有标本检测乙型肝炎血清标志物(HBsAg,HBsAb,HBeAg,HBeAb,HBcAb),部分标本检测HBV DNA。结果 筛查孕妇82214例,HBsAg阳性4924例,阳性率6.0%。随访HBsAg阳性母亲及8~12个月龄婴儿1371对,婴儿免疫阻断失败率3.1%(42/1371),HBsAg及HBeAg双阳性母亲婴儿的免疫阻断失败率为8.2%。免疫阻断失败的婴儿其母亲均为HBeAg阳性且HBV DNA≥6 log10 copies/mL。HBeAg阳性母亲孕期注射乙型肝炎免疫球蛋白(hepatitis B immune globulin, HBIG)及未注射HBIG组,其婴儿免疫阻断失败率差异无统计学意义(8.8% vs. 8.1%, P=0.807)。结论 多中心调查显示目前孕产妇HBsAg阳性率6.0%,HBV母婴阻断失败率3.1%。HBsAg及HBeAg双阳性且HBV DNA≥6 log10 copies/mL 的孕妇应为母婴阻断的重点人群。孕妇孕期注射HBIG不能提高HBV母婴阻断效果。

关 键 词:乙型肝炎病毒  孕产妇  乙型肝炎免疫球蛋白  母婴传播  免疫阻断  

A multi-center study on the efficacy of immunoprophylaxis for mother-to-infant transmission of hepatitis B virus in multi-centers.
ZHANG Lei,GUI Xi-en,WANG Bo,HE Xing-ling,ZHANG Ling,ZHU Feng-Yi,LI Li,YE Ping,LI Feng-liang,ZHOU Yun,LIU Xiao-ying.. A multi-center study on the efficacy of immunoprophylaxis for mother-to-infant transmission of hepatitis B virus in multi-centers.[J]. Chinese Journal of Practical Gynecology and Obstetrics, 2015, 31(1): 65-69. DOI: 10.7504/fk2014120114
Authors:ZHANG Lei  GUI Xi-en  WANG Bo  HE Xing-ling  ZHANG Ling  ZHU Feng-Yi  LI Li  YE Ping  LI Feng-liang  ZHOU Yun  LIU Xiao-ying.
Affiliation:*Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
Abstract:Abstract: Objective To evaluate the current positive rete of HBsAg among pregnant women and explore more effective interruption measures for mother-to-infant transmission.Methods From 2008 to 2012, pregnant women were screened for HBsAg in multi-centers (Province of Hubei, Shanxi and Guangdong and Xinjiang Uygur Autonomous Region). HBsAg positive mothers before labour and their infants aged 8~12 months in some hospitals among those areas were determined for HBV markers (HBsAg,HBsAb,HBeAg,HBeAb,HBcAb) and some of them also had HBV DNA tests.Results HBsAg positive rate of pregnant women was 6.0% (4924/82214). Infants’ immunoprophylaxis failure rate was 3.1% (42/1371) and it was 8.2% among infants of HBsAg and HBeAg positive mothers. Immunoprophylaxis failure infants were all born to mothers of HBeAg positive and HBV DNA ≥6 log10 copies/mL. Among infants of HBeAg positive mothers, immunoprophylaxis failure rates had no significant difference between mother with hepatitis B immune globulin (HBIG) and without HBIG (8.8% vs. 8.1%, P=0.807).Conclusions These findings demonstrate that pregnant women are still with high HBsAg prevalence (6.0%) in China. HBV mother-to-infant transmission (3.1%) still occurs after active-passive immunization. Pregnant women of HBsAg and HBeAg positive and HBV DNA≥6 log10
Keywords:hepatitis B virus  pregnant women  hepatitis B immune globulin  mother-to-infant transmission  immunoprophylaxis  
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