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产前和产后联合阻断 HBsAg 阳性孕妇母婴传播的研究

2017-10-11 19:00:12    作者:admin    www.5alw.com
【摘要】  目的  评价产前和产后联合阻断措施,对乙型肝炎表面抗原( HBsAg )阳性孕妇母婴传播的阻断效果。方法  将乙型肝炎表面抗原( HBsAg )阳性的孕妇在产前检查时随机分为两组,人乙型肝炎免疫球蛋白( HBIG )组: HBsAg 、 HBeAg 双阳性组孕妇产前4个月(妊娠24周起)每4周肌肉注射 HBIG 200IU 直至临产; HBsAg单阳组孕妇产前3个月(妊娠28周起)每4周肌肉注射 HBIG 200IU 直至临产;对照组孕妇不注射 HBIG。两组所生新生儿于出生后2h内及2个月取股静脉血,检测乙型肝炎病毒感染标志HBVM。双阳性组母亲分娩新生儿每10天肌肉注射 HBIG 200IU,单阳组母亲分娩新生儿每15天肌肉注射 HBIG 200IU。结果  HBIG 组母亲所生新生儿宫内感染率为 2.6%,2个月时具有保护性抗体有效保护率为95.6%;对照组母亲所生新生儿宫内感染率为 39.3%,2个月时具有保护性抗体的有效保护率为76.4%,宫内感染率比较χ2=3.86,P<0.05。结论  产前和产后联合阻断乙型肝炎病毒的母婴传播有效保护率达到95.6%,能明显减少宫内感染的发生,获得目前最大限度的提高对乙型肝炎病毒母婴传播的阻断作用。
   
    【关键词】  乙型肝炎病毒  母婴阻断  人乙型肝炎免疫球蛋白  垂直传播.
   
    【Abstract】  Objective  To evaluate the effect of combining antepartum with postpartum to break up transmission of HBV.Methods  HBV carrier mother ,whose HBsAg positive ,and later their infants were randomly divided into two groups.The gravids in group-1,whose HBsAg and HBeAg were both positive ,received 200IU HBIG every-four-week (from pregnancy for 24 week to delivery).The gravids in group-1,whose only HBsAg was positive,received 200IU HBIG every-four-week(from pregnancy for 28; week to delivery).The gravids in group-2 did not received HBIG(the control group).After delivery,all the infants in both groups obtained sera from femoral vein to test HBV markers,in two hours and at two months.The infants of mother whose HBsAg and HBeAg were positive,received 200IU HBIG every-ten-day.The infants of mother whose only HBsAg was positive ,received 200IU HBIG every-fifteen-day.Results  In group-1,the rate of intrauterine HBV infection was 2.6%,and at two-month-old,the rate of infants with the protective level against HBV infection was 95.6%.In group-2,the rate of intrauterine HBV infection was 30.3%,and at two-month-old,the rate of infants with the protective level against HBV infection was 76.4%. χ2 -test was used to compare the different rates of intrauterine HBV infection between the two groups.(χ2=3.86 P<0.05).Conclusion  More than 95.6% high-risk infants,who were born to HBsAg-positive carrier mother,were protected by the antepartum with postpartum of immunoprophylaxis,which can significantly interrupt the transmission of HBV from mothers with positive HBsAg to their infants.
   
    【Key words】  hepatitis B virus  interruption of maternal-infantile transmission  immunoglobulins of hepatitis B virus  vertical disease transmission
   
    我国是乙型肝炎的高发区,垂直传播是造成我国慢性乙型肝炎感染传播的重要原因之一 。随着乙型肝炎疫苗被列入我国计划免疫管理,使大城市内儿童的乙型肝炎病毒 (HBV) 携带率有所下降。为尽可能地减少高危儿童受HBV的母婴传播,我院自2002~2005年间,采用产前及产后联合阻断措施,对HBsAg、HBeAg双阳性及HBsAg单阳性孕妇观察预防HBV母婴传播的效果。
   
    1  对象与方法
   
    1.1  研究对象  2002~2005年在我院分娩的HBsAg阳性的孕妇,选择203例年龄在19~35岁的孕妇的新生儿做定期随访检查。
   
    1.2  方法  入选孕妇按产前检查推荐并愿意接受和未推荐或不愿接受区分为两组。一组为HBIG组,对HBsAg、HBeAg双阳性孕妇在产前4个月(24周起),对HBsAg单阳性孕妇在产前3个月(妊娠28周起)每4周肌肉注射乙型肝炎免疫球蛋白HBIG 200IU直至临产,至少3次。另一组孕妇只作检查不注射HBIG 200IU,为对照组。两组所生新生儿均于出生2h内肌肉注射HBIG 200IU,双阳性组孕妇分娩新生儿每10天肌肉注射HBIG 200IU共6次,单阳性组孕妇分娩新生儿每15天肌肉注射HBIG 200IU共4次。所有新生儿均于生后2h内及2个月时,抽股静脉血检测HBVM。同时按国家统一免疫接种,于0、1和6个月龄分别接种重组酵母基因疫苗5μg。于接种及肌肉注射HBIG前采血。
   
    HBVM检测采用国际通用的酶联免疫吸附试验(ELISA)法定量测定。分娩方式均采用剖宫产,以减少感染几率。
   
    1.3  诊断标准  HBsAg、HBeAg、HBsAb>2.1为阳性,出生时HBsAg阳性并持续至2个月月龄为宫内感染。2个月以内HBsAb转为阳性为宫内感染免疫成功。
   
    1.4  统计学方法  采用χ2检验或t检验进行统计学分析。
   
    2  结果
   
    2.1  两组新生儿宫内感染及 HBV 阻断情况  HBIG组母亲所生新生儿双阳性组56例,出生时股静脉血测HBsAg阳性3例,2个月后2例;单阳性组58例,出生时HBsAg阳性2例,2个月后1例。对照组母亲所生新生儿双阳性组40例,出生时HBsAg阳性19例,2个月15例;单阳性组49例,出生时HBsAg阳性16例,2个月12例,见表1。    
    
           表1  两组新生儿的有效阻断率及宫内感染率  (例)   

    2.2  两组婴儿HBsAg阳性例数及平均值  对两组新生儿2个月HBsAb定量测定,结果见表2。 

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