乙肝疫苗联合乙肝免疫球蛋白对阻断母婴垂直传播乙型肝炎病毒的临床分析

目的探讨孕妇产前用乙肝免疫球蛋白（HBIG）与乙型肝炎疫苗联合免疫阻断母婴传播的效果。方法将504例HBsAg（＋）孕妇分为A（预防组）,B（对照组）两组。A组：246名HBsAg阳性孕妇孕晚期每月分别注射基因重组型乙肝疫苗10μg、HBIG200IU（200IU/ml）,新生儿出生后采股静脉血,同时在出生后24h内注射HBIG200IU,然后在0、1、6月龄接种基因重组型乙肝疫苗,每次10μg。B组：258例产前未注射HBIG和基因重组型乙肝疫苗的HBsAg阳性孕妇,其所生新生儿在0、1、6（30μg、30μg、30μg）月龄只用基因重组型乙肝疫苗免疫。A、B两组婴儿都分别在0、3、6、9、12、24月龄静脉采血,用酶联免疫吸附试验（ELISA）检测HBV标志物,同时随访。结果A组的宫内感染率为3.25%,B组为4.16%,差异无统计学意义（χ^2=1.43,P〉0.05）。A组没有发生慢性HBV感染的婴儿,而B组中有7例婴儿发生慢性HBV感染,B组婴儿发生慢性HBV的感染率显著高于A组（χ^2=4.41,P〈0.05）。结论产前用HBIG和新生儿HBIG联合免疫可降低慢性HBV感染率,阻断宫内感染的慢性化,提高产程感染的阻断效果。

Clinical Analysis on the Effects of HBIG and Hepatitis B Vaccine on the Prevention of the Vertical Transmission of HBV from Mother to Newborn Infants

Objective To study the effect of HB immunoglobulin（HBIG） and hepatitis B vaccine on mothers during the third trimester of pregnancy on the blocking of mother-to-infant transmission of HBV. Method A total of 504 HBsAg positive mothers were divided into two groups： group A, treated with HBIG 200 IU （200 IU/ml） and HB vaccine during the third trimester of pregnancy and their infants with HBIG 200 IU at birth and three 10 μg doses of recombinant vaccine were given at 0, 1 and 6 months ; group B, without HBIG and HB vaccine treatment during the third trimester of pregnancy and their infants with three 30 μg doses of recombinant vaccine given at 0, 1 and 6 months. All infants were followed up for the hepatitis B detection at the age of 0, 3,6,9,12,24 months by enzyme-linked immunoadsorbent assay（ELISA）. Result The intrauterine infection rates in group A and group B were 3.25% and 4.16%, respectively. No significant difference was observed. No infants were infected chronically by HBV in group A. 7 infants who were infected chronically with HBV were all in group B. The chronical infection rate of HBV of infants in group B was significantly higher than that in group A （χ^2=4.41 ,P 〈 0.05）. Conclusion Use of HB immunoglobulin （HBIG） and hepatitis B vaccine to treat the HBsAg positive mothers during the third trimester of pregnancy and combined the use of HBIG and HB vaccine to infants could block the chronic infection of HBV resulting from intrauterine infection.