【摘要】 目的探讨乙型肝炎病毒(HBV)表面抗原(HBsAg)阳性、同时HBV-DNA阳性(双阳性)母亲经乙肝高效价免疫球蛋白(HBIG)和乙肝疫苗联合免疫后所产婴幼儿的免疫效果及注射HBIG方法不同对双阳性孕妇的HBV宫内感染阻断作用。方法将228例双阳性孕妇分为4组:A组于妊娠26周、30周和34周时分别肌肉注射基因工程乙肝疫苗20μg,共3次;B组于妊娠26周、30周和34周时分别肌肉注射HBIG200 U,共3次;C组于妊娠26周、30周和34周时分别肌肉注射基因工程乙肝疫苗20μg,共3次,同时于妊娠28周、32周和36周时分别肌肉注射HBIG200 U,共3次;D组(对照组)孕期未进行任何阻断乙肝母婴传播的干预。4组新生儿均于出生后6 h内和2周注射HBIG200 U,满月起按l、2、7月龄分别接种乙肝疫苗,并定期随访。结果 A、B、C、D4组宫内感染率分别为7.8%、14.0%、7.7%、29.0%,A、B、C组新生儿的HBsAg阳性率在出生时、出生后6个月及12个月时均低于D组,差异均有统计学意义(P<0.05);而A、B、C组间差异无统计学意义(P>0.05)。抗-HBs阳性率在出生后12个月时分别为86.3%、82.0%、89.2%和62.9%,而A、B、C组的抗-HBs阳性率在出生后6个月及12个月均高于D组(P<0.05)。4组新生儿出生时抗-HBs阳性率比较,差异无统计学意义(P>0.05)。结论对HBsAg伴HBV-DNA双阳性孕妇,选择注射乙肝疫苗、HBIG或乙肝疫苗联合HBIG注射能有效减少HBV宫内感染的发生率。更多还原

【Abstract】 Objective To explore the efficacy of hepatitis B immunoglobulin(HBIG) combined with hepatitis B vaccine in HBsAg+/HBV-DNA+ pregnant women.Methods A total of 228 HBsAg+/HBV-DNA+ pregnant women were divided into four groups:groups A received 20 μg of hepatitis B vaccine on the 26th,30th,and 34th gestational week;group B received 200 IU of HBIG on the 26th,30th,and 34th gestational week;group C received 20 μg of hepatitis B vaccine on the 26th,30th,and 34th gestational week and 200 IU of HBIG on their 28th,32nd,and 36th gestational week;and Group D,as a control group,received neither HBIG nor hepatitis B vaccine injection.All the newborns from these mothers received 200 IU of HBIG both within 6 hours and 2 weeks after birth and were vaccinated against Hepatitis B 1 month,2 months,and 7 months after birth via routine follow-up.Results The intrauterine infection rates of HBV were 7.8%,14.0%,7.7% and 29.0% in these four groups,respectively.HBsAg positive rates among newborns were significantly lower in groups A,B,and C than in group D(P<0.05),but showed no statistical difference among the former three groups(P>0.05).The positive rate of anti-HBsAg was significantly higher in group A(86.3%),group B(82.0%),and group C(89.2%) than in group D(62.9%)(P<0.05).The positive rate of anti-HBsAg in newborns were not statistically different among these four groups(P>0.05).Conclusion Hepatitis B immunoglobulin(HBIG) combined with hepatitis B vaccine is effective in preventing intrauterine infection among HBsAg+/HBV-DNA+ pregnant women.更多还原