妊娠晚期注射乙肝免疫球蛋白阻断乙肝病毒母婴传播的临床研究

目的：研究孕妇妊娠晚期注射乙肝免疫球蛋白对阻断乙肝病毒母婴传播的影响。方法：选取2011年1月-2013年1月间入院诊治的乙肝表面抗原、乙肝e抗原均为阳性的孕妇160例，根据数字随机表法随机分为实验组（80例）和对照组（80例）。其中实验组在妊娠28周开始每间隔4周肌肉注射一次乙肝免疫球蛋白（200IU ），共注射3次；对照组妊娠晚期不注射乙肝免疫球蛋白。在胎儿娩出后手挤脐静脉血进行乙肝表面抗原测定，观察妊娠晚期注射乙肝免疫球蛋白对婴儿免疫效果的影响。结果：新生儿感染情况中，实验组 HBsAg 与 HBeAb 均阴性69例，占86.25％，对照组为57例，占71．25％；仅 HBsAg阳性实验组10例，占12．50％，对照组18例，占22．50％；HBsAg与HBeAb均阳性实验组1例，占1．25％，对照组5例，占6．25％；实验组宫内感染率为12．50％，对照组为27．50％；两组差异显著（ P＜0．05）。感染风险比较中，实验组孕妇极低风险组22例，新生儿感染率为9．09％，对照组孕妇极低风险组23例，新生儿感染率13．04％，两组无显著差异（ P＞0．05）；实验组孕妇低风险组26例，新生儿感染率15．38％，对照组孕妇低风险组23例，新生儿感染率为21．74％，两组无显著差异（ P＞0．05）；实验组孕妇高风险组32例，新生儿感染率为15．63％，对照组孕妇高风险组34例，新生儿感染率为44．12％，两组差异显著（ P＜0．05）。结论：妊娠晚期肌注 HBIG可有效降低宫内感染率；对于孕期 HBV-DNA极低风险或低风险的孕妇，妊娠晚期注射 HBIG对阻断母婴传播无明显效果；而HBV-DNA高风险孕妇妊娠晚期注射 HBIG可有效减少新生儿 HBsAg阳性率。

Clinical Studies of Mother to Child Transmission of Hepatitis B Virus in Late Pregnancy Injection of Hepatitis B Immuno-globulin Blocking

Objective ：To study the pregnancies in late injection of hepatitis B immunoglobulin blocking effect on moth-er to child transmission of hepatitis B virus .Methods ：Between January 2011 to January 2013 admitted for treatment of hepatitis B surface antigen ,hepatitis Be antigen-positive pregnant women were 160 cases ,according to figures randomly were randomly divided into experimental group （80 cases） and control group （80 cases） .Each experimental group at 28 weeks of pregnancy intervals beginning four weeks intramuscularly once a hepatitis B immune globulin （200 IU） ,a total of three injections ;late pregnancy does not control injection of hepatitis B immune globulin .After the fetus phone cord blood of hepatitis B surface antigen determination to observe the effects of injection of hepatitis B immune globulin in late pregnancy on infant immunization effect .Results ：Neonatal infection ,the experimental group were negative for HB-sAg and HBeAb 69 cases ,accounting for 86 .25% in the control group 57 cases ,accounting for 71 .25% ;10 cases of HBsAg positive only in the experimental group ,accounting for 12 .50% ,control group 18 cases ,accounting for 22.50% ;HBsAg were positive with HBeAb experimental group 1 case ,accounting for 1 .25% of the control group ,5 cases （6 .25% ）;experimental intrauterine infection rate was 12 .50% in the control group was 27 .50% ;difference was significant （P〈0 .05） .Comparison of the risk of infection ,22 cases of low-risk group of pregnant women in the experi-mental group ,neonatal infection rate was 9 .09% ,23 cases of low-risk group of pregnant women in the control group , 13 .04% of neonatal infection ,there was no significant difference （P〉0 .05）;26 cases of low-risk group of pregnant women in the experimental group ,neonatal infection rate 15 .38% ,the low-risk group of pregnant women in the control group ,23 cases of neonatal infection rate was 21 .74% ,there was no significant difference （P〉 0 .05）;experimental group of high-risk pre