孕妇HBIG被动免疫阻断HBV母婴垂直传播的临床研究

目的 :研究HBV阳性孕妇孕期应用高效价乙肝免疫球蛋白HBIG预防HBV宫内感染的作用机理。方法 :将 1 0 0例乙肝表面抗原HBsAg阳性孕妇随机分为两组 ,预防组 6 0例 ,于孕 2 8、32、36周肌肉注射HBIG三次 ,每次2 0 0IU ;对照组 4 0例 ,只随访查体不用药。两组孕妇所生婴儿均于出生后 2 4小时内肌肉注射HBIG 1 0 0IU一次 ,注射乙肝疫苗时间和剂量均按正常婴儿的操作方案进行。母儿血清HBsAg ,HBeAg和抗 -HBs用固相放免法检测 ,HBV -DNA用荧光定量PCR检测。结果 :HBIG预防组孕妇的婴儿HBV感染率显著低于对照组 (P <0 .0 5 ) ;预防组婴儿血清抗 -HBs检出率显著高于对照组 (P <0 .0 0 1 ) ;HBV -DNA含量显著低于对照组 (P <0 .0 5 )。结论 :孕妇于孕期多次注射HBIG进行被动免疫可有效地阻断乙型肝炎病毒母婴传播 ,减少婴儿HBV感染率

A Clinical study on Passive Immunization of Hepatitis B Immunoglobulin Blocking the Hepatitis B Virus to the Maternal- infantile Vertical Transmission Action

Objective:To study on the mechanism of passive immunization with hepatitis B immunoglobulin (HBIG) on the prevention of HBV intrauterine infection.Methods:100 cases of HbsAg positive pregnant women were devided into two groups.In the prophylaxis group,60 cases were injected with HBIG at 28.32,36 week during pregnancy(100IU per time).In the control group,40 cases were followed-up without injection of HBIG.All newborns of the 2 groups were received 100IU of HBIG intramuscularly within 24 hours after birth and were immunized with three doses of hepatitis B vaccine within 24 hours after birth,one month and six month's of age,respectively.Serum HbsAg hepatitis Be antigen(HbeAg) and hepatitis B surface antibody (Anti-HBS) in all pregnant women.And infants were detected with solid phase radioimmunoassay(SPRIA),and hepatitis B virus DNA(HBV-DNA) was detected with fluorescence quantitative polymerase chain reaction(FQ-PCR).Results:In HBIG prophylaxis group,the vertical transmission incidence of the infants was lower than those in control groups(P<0.05).The detection rate of anti-HBS of prophylaxis group was significantly higher than those in control groups(P<0.001).HBV-DNA load of the prophylaxis group were lower than those of the control group(P<0.05).Conclusions:Administration of multiple HBIG intramuscularly during pregnancy is a passive immunoprophylaxis method for pregnant women.The method can efficiently interrupt maternal-fatal transmission of heatitis B virus and decrease the HBV infection rate of infants.The mechanism may be attributed to reducing the pregnant women's HBV viraemia and making the infants to gain passive immunoprophylaxis.