孕妇乙肝免疫球蛋白被动免疫阻断HBV母婴垂直传播作用机理的研究

目的 :研究HBV阳性孕妇孕期应用乙肝免疫球蛋白 (HBIG)预防HBV宫内感染的作用机理。方法 :将 78例乙肝表面抗原 (HBsAg)阳性孕妇分为两组 :预防组 30例 ,于孕 2 8、32、36周肌肉注射HBIG 3次 ,每次 2 0 0IU ;对照组 4 8例 ,只随访查体不用药。检测母儿血清乙肝标志物 (HBVM)和细胞因子IFN γ ,IL 12 ,IL 6水平用双抗夹心酶联免疫吸附法 (DAS ELISA) ,测定HBVDNA含量用荧光定量PCR(FQ PCR)技术。结果 :78例HB sAg阳性孕妇分娩的新生儿宫内感染 10例 ,宫内感染率为 12 .82 % .HBIG预防组孕妇的胎儿HBV感染率显著低于对照组 (P <0 .0 5 ) ;预防组新生儿脐血清抗 HBs检出率显著高于对照组 (P <0 .0 0 1) ;预防组孕妇血清中IFN γ ,IL 12水平显著高于对照组 (P <0 .0 5 ) ,IL 6水平、HBVDNA含量则显著低于对照组 (P <0 .0 5 )。结论 :孕妇HBIG被动免疫可有效阻断HBV母婴垂直传播。

Study on the mechanism of 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:78 cases of HBsAg positive pregnant women were divided into two groups. In the prophylaxis group,30 cases were injected with HBIG at 28, 32, 36 week during pregnancy (200 IU per time).In the control group,48 cases were followed-up without injection of HBIG. By using diantibody sandwich enzyme linked immunosorbant assay (DAS-ELISA) and fluorescence quantitative polymerase chain reaction (FQ-PCR),the HBV marker(HBV M),activities of IFN-γ,IL-12,IL-6 and HBV DNA load in the blood samples of mothers and their neonates were tested respectively. Results:The incidence of HBsAg positive pregnant women's intrauterine infection was 12.82% (10/78). In HBIG prophylaxis group, the vertical transmission incidence of the newborns was lower than those in control group (P<0.05). The detection rate of anti-HBs of prophylaxis group was significantly higher than those in control group(P<0.001). In the pregnant women of the prophylaxis group,activities of IFN-γ and IL-12 were significantly higher than those in control group, but the IL-6 activity and HBV DNA load of the former group were lower than those of control group (P<0.05). Conclusions:Passive immunization with HBIG of pregnant woman can block maternal-infantile vertical transmission of HBV infection effectively.