乙型肝炎病毒携带者母乳喂养的研究

目的探讨乙型肝炎(乙肝)病毒(hepatitis B virus，HBV)携带者在其新生儿、婴儿接受被动及主动全程联合免疫的条件下，是否可以母乳喂养。方法对2001年9月至2003年10月间妊娠期无症状HBV携带者所娩婴儿进行前瞻性随访研究，新生儿出生时留取脐血检测HBV脱氧核糖核酸(HBV DNA)，出生后12h内及第14天注射乙肝免疫球蛋白，并按0、1、6的程序全程接种乙肝疫苗，由产妇自愿选择母乳喂养或人工喂养，55例母乳喂养，36例人工喂养。分别于婴儿7个月和12个月时随访检测HBV DNA及乙肝血清标志物，婴儿7个月时未感染乙肝但抗-HBs阴性者给予乙肝疫苗5μg加强注射。结果婴儿7个月和12月时，母乳喂养组HBV DNA阳性率分别为9．09％(5／55)及9．09％(5／55)，抗HBs阳性率分别为85．45％(47／55)及90．90％(50／55)；人工喂养组HBVDNA阳性率分别为8．33％(3／36)及8．33％(3／36)，抗HBs阳性率分别为86．11％(31／36)及91．67％(33／36)。母乳喂养与人工喂养相比，差异均无统计学意义。结论在新生儿、婴儿接受被动及主动全程联合免疫的条件下，无症状HBV携带者可以母乳喂养。

Study on breast-feeding in hepatitis B virus carrier women

Objective To explore the possibility of breast feeding in chronic asymptomatic hepatitis B virus (HBV) carriers after immuno prophylaxis of the infants. Methods The infants with asymptomatic HBV carriers mothers were selected by the obstetric department of Qilu Hospital of Shangdong University, Jinan Maternity and Infant Health Institute of Shangdong from Sept 2001 to Oct 2003 prospectively. Umbilical blood HBV deoxyribonucleic acid (HBV DNA) was detected at birth. All infants received 200 IU HBV specific immunoglobin(HBIG)within 12 hours and on 14 days after birth. The hepatitis B recombinant vaccine was given within 24 hours after birth and at 1 and 6 months of age. The way of feeding was chosen by the mothers as they liked. There were 55 infants in breast feeding group and 36 in bottle feeding group. Infants were then followed up at 7 and 12 months of age and tested for hepatitis B surface antigen(HBsAg), hepatitis B surface antibody (anti HBs), hepatitis B e antigen(HBeAg), hepatitis B e antibody(anti HBe) and hepatitis B core antibody(anti HBc) and HBV DNA. Uninfected infants with negative anti HBs were given repeated dose of vaccinations. Results At 7 and 12 months of age, the positive rates of HBV DNA were 9.09%(5/55)and 9.09%(5/55), anti HBs were 85.45%(47/55)and 90.90%(50/55)in breast feeding group respectively;while the positive rates of HBV DNA were 8.33%(3/36)and 8.33%(3/36), anti HBs were 86.11%(31/36)and 91.67%(33/36)in bottle feeding group respectively. No significant differences was shown in positive rates of HBV DNA and anti HBs between these two groups. Conclusions With appropriate immunoprophylaxis, including hepatitis B immune globulin and hepatitis B vaccine, HBV carriers can breast feed their babies.