不同方法注射乙肝免疫球蛋白阻断HBsAg、HBeAg双阳性孕妇母婴传播的研究

目的研究不同方法注射乙肝免疫球蛋白(HBIG)对HBsAg伴HBeAg双阳性孕妇的乙肝病毒(HBV)宫内感染阻断作用。方法将137例双阳性孕妇分为4组:A组从孕16周起注射HBIG,B组从孕20周起注射HBIG,C组从孕28周起注射HBIG,A、B、C 3组孕妇每次均注射HBIG200IU,并间隔4周1次,直至临产;D组作为对照组,不注射HBIG;出生后4组所有新生儿均于16h内和生后2周注射HBIG200IU,满月起按1、2、7月龄分别接种乙肝疫苗,并定期随访。结果新生儿出生时外周血测得HBsAg,A组与B组无显著性差别(P>0.05),A、B 2组与C组、D组以及C组与D组均有显著性差别(P均<0.05);经随访A、B、C、D 4组HBV宫内感染率分别为5.6%、5.3%、19.4%和48.5%,母婴传播阻断率A组与B组无显著差异(P>0.05),A组和B组均显著高于C组和D组、C组显著高于D组(P均<0.05)。结论对HBsAg伴HBeAg双阳性孕妇,选择孕20周开始注射HBIG比较合适,阻断率最高,能有效减少HBV宫内感染的发生率。

Study on interrupting vertical transmission of HBsAg- and HBeAg positive pregnant women by different methods of Injecting HBIG

Objective: To study the interruption effects of different phases of injecting HBIG into both HBsAg and HBeAg positive pregnant women.Methods:137 cases of double positive pregnant women were divided into four groups.Groups A,B and C received 200IU of HBIG every 4 weeks until delivery since their respective 16th,20th and 28th week of gestation.Group D,as a control group,received no HBIG.All the newborns in these groups received 200IU of HBIG within 16 hours and 2 weeks after birth,were vaccinated against Hepatitis B and followed up regularly.Results: Groups A and B were of no significant difference(P>0.05),but there were noticeable differences between the first two groups and Group C,between Group C and Group D(P<0.05 in both) when the newborns were examined.Through follow-ups,intrauterine infection rates of HBV were 5.6%,5.3%,19.4% and 48.5% in these four groups.The interruption rates of maternal-neonatal transmission were of no significant difference between Groups A and B(P>0.05),but their differences were significant compared with those in Groups C and D,and Group C is also of significant difference in comparison with Group D(P<0.05 in all).Conclusion: It is best to inject HBIG into double positive pregnant women at 20th week of gestation,for at this time interruption rate is highest and intrauterine infection rates can be decreased effectively.