联合免疫预防乙型肝炎病毒宫内感染的临床观察

目的:探讨孕妇主动与被动联合免疫乙型肝炎病毒(HBV)宫内感染的作用和机理。方法:将106例HBsAg( )孕妇分成两组,预防组60例,自孕妇20周起多次注射乙肝疫苗(HBVac)和乙肝免疫球蛋白(HBIG);对照组46例,不用HBVac和HBIG。母婴血清HBsAg、HBeAg和HBsAb用固相放免法检测,HBV-DNA用有套式PCR检测。结果:预防组新生儿血清HBsAg和HBV-DNA检出率明显低于对照组(P<0.05);预防组新生儿HBsAb阳性率显著高于对照组(P<0.05)。结论:孕妇于孕期通过HBIG和HBVac联合免疫,可有效预防HBV宫内感染,其机理可能为胎儿获得被动免疫。

Clinical observation on combination immunization in preventing intrauterine HBV infection

Objective: To study the efficacy and possible mechanism of active and passive immunization on pregnant woman in preventing intrauterine HBV infection.Methods: 106 pregnant women with HBsAg positive were divided into two groups.In the prevention group,60 cases were injected with hepatitis B vaccine(HBVac)and hepatitis B immunoglobulin(HBIG)during pregnancy since the 20th week of gestation).In the control group,46 cases without injection of HBV ac or HBIG.HBsAg,HBeAg and anti-HBs were tested with solid phase radio immunoassay and HBV-DNA in serum was detected with nested polymerase chain reaction in maternal and neonates.Results: The detection rate of the HBsAg and HBV-DNA in the newborns of prevention group was significantly lower than that of the control group(3.3% vs.26.1%,10% vs.34.8%,P<0.05,respectively);the detection rate of anti-HBs was significantly higher in the newborns of the prevention group than that of the control group(33.3% vs.8.7%,P<0.05).Conclusion: Immunization with HBVac and HBIG during pregnancy may prevent intrauterine HBV infection effectively and its mechanism may be that the fetuses acquire passive immunization.