免疫阻断乙型肝炎病毒母婴传播多中心研究

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。

A multi-center study on the efficacy of immunoprophylaxis for mother-to-infant transmission of hepatitis B virus in multi-centers.

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