孕妇乙型肝炎病毒携带状态与阻断母婴传播的研究

目的:研究HBsAg阳性孕妇产前应用HBIG、新生儿联合应用HBIG和乙肝疫苗阻断乙肝病毒母婴传播的效果。方法:98例HBsAg阳性孕妇在孕28、32、36周时肌内注射乙型肝炎人免疫球蛋白(HBIG)200 IU,新生儿出生采股静脉血后,臀部肌内注射HBIG 200 IU,三角肌内注射重组乙型肝炎疫苗(酵母)10μg,1月龄时再次注射HBIG 200 IU,1、6月龄常规注射乙肝疫苗10μg,作为实验组;选取92例产前未使用HBIG的HBsAg阳性孕妇作为对照组,所生婴儿仅0、1、6月龄注射重组乙型肝炎疫苗(酵母)10μg。两组婴儿分别在0、1、6、12月龄时采静脉血,检测HBV标志物,随访两组婴儿至1岁。观察、比较两组婴儿的宫内感染率、慢性感染率、保护率及免疫失败率。结果:实验组和对照组宫内感染率分别为3.06%和18.48%,两组比较差异有统计学意义(P<0.01);实验组和对照组慢性感染率分别为1.02%和13.04%,两组比较差异有统计学意义(P<0.01);实验组和对照组保护率分别为95.92%和76.09%,两组比较差异有统计学意义(P<0.01);实验组和对照组免疫失败率分别为1.02%和7.61%,两组比较差异无统计学意义(P>0.01)。结论:HBsAg阳性孕妇产前应用HBIG、新生儿出生后应用HBIG和乙肝疫苗联合免疫,可有效阻断母婴垂直传播,提高婴儿的免疫成功率,明显降低慢性HBV感染率。

Study on HBV carrier status of pregnant women and block of maternal-infant transmission of hepatitis B virus

Objective:To research the effects of application of hepatitis B immunoglobulin(HBIG) before delivery,combined application of HBIG of neonates,and hepatitis B vaccine on block of maternal-infant transmission of hepatitis B virus(HBV). Methods:A total of 98 HBsAg positive pregnant women were selected,then they were treated with intramuscular injection of 200 IU HBIG at 28,32,and 36 gestational weeks,femoral venous blood samples of the neonates were obtained at birth,then the neonates were treated with intramuscular injection of 200 IU HBIG in coxal muscle and 10 μg recombinant hepatitis B vaccine(yeast),when they were one month,they were treated with intramuscular injection of 200 IU HBIG,and they were injected with hepatitis B vaccine conventionally when they were one month and six months,the pregnant women were designed as experimental group;92 HBsAg positive pregnant women who weren’t be treated with HBIG were selected as control group,their neonates were injected with 10 μg recombinant hepatitis B vaccine(yeast) at birth,one month,and six months.The venous blood samples of the neonates in the two groups were obtained at birth,one month,six months,and twelve months,respectively;HBV markers were detected;the neonates in the two groups were followed up until one year.The intrauterine infection rates,the chronic infection rates,the protective rates,and the failure rates of immunization in the two groups were compared. Results:The intrauterine infection rates in experimental group and control group were 3.06% and 18.48%,respectively,there was statistically significant difference between the two groups(P<0.01);the chronic infection rates in experimental group and control group were 1.02% and 13.04%,respectively,there was statistically significant difference between the two groups(P<0.01);the protective rates in experimental group and control group were 95.92% and 76.09%,respectively,there was statistically significant difference between the two groups(P<0.01);the failure rates of immunization in experimental group and control group were 1.02% and 7.61%,respectively,there was no statistically significant difference between the two groups(P>0.01). Conclusion:Application of HBIG before delivery,combined application of HBIG of neonates,and hepatitis B vaccine can block maternal-infant transmission of HBV,improve the successful rate of immunization,and reduce the chronic infection rate of HBV.