孕妇注射乙肝免疫球蛋白阻断HBV宫内传播的研究

目的 :研究乙型肝炎免疫球蛋白 (HBIG)对HBsAg阳性孕妇的乙肝病毒 (HBV)宫内阻断作用及孕妇血清中HBVDNA水平与宫内感染的关系。方法 :HBIG组 5 6例 ,孕 2 8周起肌注HBIG ,每 4周一次至分娩 ;对照组 5 2例 ,未予用药。两组孕妇均于孕 2 8周、分娩前 ,其新生儿于生后 2 4小时内免疫接种前抽静脉血检测HBsAg ,HBeAg及HBVDNA定量。结果 :HBIG组孕妇HBVDNA水平显著下降 (P <0 .0 5 ) ,其新生儿宫内感染率明显低于对照组 (分别为 16 .1%和 32 .7% ) ,P <0 .0 5。胎儿宫内感染率随着孕妇血清中HBVDNA含量增加而呈现增高趋势 (P <0 .0 5 )。两组孕妇及其新生儿未发现有不良反应。结论 :携带HBV孕妇产前多次注射HBIG可有效减少HBV宫内感染发生率 ;孕妇血清HBVDNA水平增高是胎儿发生HBV宫内感染的重要因素之一

Clinical study on interruption of HBV transmission in uterus by injecting HBsAg positive pregnant women with multiple HBV specific immunoglobulin before delivery

The:To study the interruptive effect of HBV specific immunoglobulin (HBIG)in HBsAg positive pregnant women before delivery in the prevention of intrauterine transmission of HBV and the relationship between serum HBV DNA load and intrauterine infection of their newborns. Methods:Each subject in the HBIG group(56 cases) received 200 IU of HBIG intramusculaly every 4 weeks before delivery since the 28th week of gestation; The control group(52 cases)were followed up without any specific treatment. Blood specimens were tested for HBsAg and HBeAg by enzyme linked immunosorbent assay(ELISA), HBV DNA by fluorenscence quantitative polymerase chain reaction (FQ-PCR) in all the subjects at the 28th week of gestation and before delivery, and their neonates in 24 hours after birth before the administration of immune prophylaxis. Results: HBV DNA in the HBIG guoup decreased obviously (P<0.05) and the rate of intrauterine infection in the HBIG group was significantly lower than that of control group (16.1% vs 32.7%, P<0.05).Furthermore,with the increase of serum HBV DNA load,the risk of intrauterine infection was increasing (P<0.05).No side effects were found in the pregnant women and their neonates. Conclusions: Our study shows that HBV intrauterine infection can be interrupted by using multiple HBIG intramuscularly before delivery and fetal exposure to high level of maternal HBV DNA is one of the important factors of intrauterine infection.