【摘要】 目的研究联合免疫措施阻断乙型肝炎病毒(HBV)母婴传播对新生儿血清中HBsAg水平影响。方法选取2016年8月-2017年2月医院HBsAg阳性孕妇468例为研究对象,根据随机数字表法,按照1∶1比例将研究对象随机分为试验组和对照组,每组234例。对照组采用乙肝疫苗接种,试验组采用联合免疫措施(乙肝免疫球蛋白联合乙肝疫苗接种)。观察和比较两组研究对象乙肝血清标志物(HBVM)、血清丙氨酸氨基转移酶(ALT)、HBV-DNA等指标水平和阻断效果及宫内感染率。结果试验组新生儿脐血检测HBsAg(+)率、HBsAg(+)/HBeAg(+)率、HBeAg(+)率、HBV-DNA(+)率、宫内感染率均低于对照组(P<0.05),抗-HBs检出率90.17%高于对照组68.38%(P<0.05);试验组新生儿6个月静脉血HBsAg(+)率、HBsAg(+)/HBeAg(+)、HBeAg(+)率、HBV-DNA(+)率、HBV感染率均低于对照组(P<0.05),抗-HBs检出率85.04%、抗-HBs检出(>10mIU/mL)率72.65%高于对照组的68.38%、50.00%(P<0.05);试验组新生儿12个月静脉血HBsAg(+)率、HBsAg(+)/HBeAg(+)率、HBV-DNA(+)率、HBV感染率均低于对照组(P<0.05);抗-HBs检出率94.87%、抗-HBs检出(>10mIU/mL)率90.17%高于对照组的79.06%、70.94%(P<0.05)。结论乙肝免疫球蛋白联合乙肝疫苗接种阻断HBV母婴传播效果较好,能有效提高抗-HBs检出率(>10mIU/mL)、降低新生儿血清中HBsAg(+)率,因此在孕检期间出现血清HBVM抗原阳性者,应采用联合免疫措施阻断HBV母婴传播。更多还原

【Abstract】 OBJECTIVE To study the effect of co-immunization on the level of HBsAg in neonatal serum by blocking maternal-infant transmission of hepatitis B virus(HBV).METHODS A total of 468 cases of HBsAg positive pregnant women treated in our hospital from Aug.2016 to Feb.2017 were selected as research sujects.According to the 1∶1 ratio,the subjects were randomly divided into the observation group and the control group(234 cases in each group).The control group was vaccinated with hepatitis B vaccine,and the observation group was immunized with combined immunoglobulin(HBV immunoglobulin combined with hepatitis B vaccine).The serum markers(HBVM),serum alanine aminotransferase(ALT)and HBV-DNA levels,the blocking effect and intrauterine infection rate of the two groups were observed and compared.RESULTS The HBsAg(+)rate,HBsAg(+)/HBeAg(+),HBeAg(+)rate,HBV-DNA(+)rate and intrauterine infection rate of the newborns in the observation group were all signifcantly lower than those of the control group(P<0.05).The detection rate of anti-HBs was 90.17%,higher than that of the control group(68.38%)(P<0.05).In the infants of the observation group at an age of 6 months,the HBsAg(+)rate,HBsAg(+)/HBeAg(+),HBeAg(+)rate,HBV-DNA(+)rate,and HBV infection rate were all signifcantly lower than those of the control group(P<0.05).The detection rate of anti-HBs was 85.04%,and the anti-HBs detection(>10 mIU/mL)was 72.65%,signifcantly higher than those of the control group(68.38% and 50.00%),(P<0.05).In the venous blood of the infants at an age of 12 months,the HBsAg(+)rate,HBsAg(+)/HBeAg(+),HBV-DNA(+)rate,and HBV infection rate in the observation group were all signifcantly lower than those of the control group(P<0.05).The detection rate of anti-HBs was 94.87%,and the anti-HBs detection(>10 mIU/mL)was 90.17%,signifcantly higher than those of the control group(79.06% and 70.94%)(P<0.05).CONCLUSION Hepatitis B immunoglobulin combined with hepatitis B vaccination has a significant effect in blocking maternal-infant transmission of HBV,which can effectively increase the detection rate of anti-HBs(>10 mIU/mL)and reduce the HBsAg(+)rate in neonatal serum.Therefore,in patients with positive serum HBVM antigens during the pregnancy test,co-immunization measures should be used to block HBV maternal-infant transmission.更多还原