HBsAg阳性孕妇产前应用乙型肝炎免疫球蛋白提高婴儿对乙型肝炎疫苗的免疫反应  

Use of hepatitis B immunoglobulin before delivery can improve the immune response to hepatitis B vaccine of infants from HBsAg positive mothers

作　　者：肖小敏[1] 陈新[1] 李耘[1] 叶志海[1] 何明娇[1] 徐玉苑[1] 

机构地区：[1]暨南大学附属第一医院妇产科,510630

出　　处：《新医学》2005年第10期567-569,共3页Journal of New Medicine

摘　　要：目的:探讨HBsAg阳性孕妇在孕晚期应用乙型肝炎免疫球蛋白(hepatitis B immunoglobu-lin,HBIG)可否改善其婴儿对乙型肝炎疫苗(乙肝疫苗)的免疫应答能力.方法:291例HBsAg阳性孕妇,分为HBsAg、HBeAg均阳性的A组(83例),HBsAg阳性、HBeAg阴性的B组(208例),按患者知情同意的原则,A组59例、B组116例在孕晚期应用HBIG(200 U,每4周1次),为HBIG组,其余孕晚期未应用HBIG为非HBIG组.两组孕妇所生婴儿均在出生当日、1月龄分别注射乙肝疫苗5μg.检测6月龄婴儿外周血的乙型肝炎病毒血清标志物,比较与分析各组6月龄婴儿的乙型肝炎病毒携带率及抗-HBs阳转率.结果:①非HBIG组的婴儿6月龄抗-HBs阳转率在A、B组分别为38%及64%,两组间比较差异有统计学意义(P＜0.05);HBIG组6月龄婴儿抗-HBs阳转率在A、B两组分别为81%及85%,均显高于非HBIG组(P＜0.05).②孕晚期应用3次HBIG者,其6月龄婴儿HBsAg、抗-HBs阳转率与应用1～2次HBIG者比较,差异无统计学意义.结论:HBsAg阳性(尤其是HBeAg同时阳性)孕妇的婴儿对乙型肝炎疫苗的免疫反应性较低,孕晚期应用HBIG可有效提高HBsAg阳性孕妇所生婴儿对乙型肝炎疫苗的免疫应答反应.Objective： To study the effect of using HBIG during the third trimester of pregnane） on improving the immune response to hepatitis B vaccine in infants from HBsAg positive mothers, Methods： 291 mothers of HBsAg c：arriers were enrolled, of whom 83 cases with HBsAg （ ＋ ） /HBeAg （ ＋ ） served as Group A, and 208 cases with HBsAg （ ＋ ） /HBeAg （ - ） served as Group B. With informed consent, 59 eases in Group A and 116 cases in Group B were given HBIG （200 U/4 weeks） during the third trimester （ HBIG group） , while others were not given HBIG （noll-HBIG group. All infants received 5 μg hepatitis B vaccine at the age of 0, 1 month respectively, The peripheral venous blood samples of all babies at the age of 6 months were tested for HBV serological markers. The positive rates of HBV serological markers and anti-HBs were compared among groups. Results： ① In non-HBIG group, the anti-HBs protective rates of 6 months infants in Groups A and B were 38% and 64% respectively, and the rate in Group A was significantly louver than that in Group B. In HBIG group, the anti-HBs positive rate of 6 months infants in Groups A and B were 81% and 85% respectively, significantly higher than that in non-HBIG group. ②No matter the infants from mothers who receive 1 -2 or 3 dose of HBIG, the anti-HBs positive rate in 6 months infants were not significantly different, Conclusion： Infants from mother with HBsAg positive, particularly with both HBsAg and HBeAg positive, may have poor immune response to hepatitis B vaccine. Using HBIG during the third trimester of pregnancy can improve the immune response to hepatitis B vaccine of infants from HBsAg positive mothers.

关 键 词：肝炎病毒 乙型 垂直传播 乙型肝炎免疫球蛋白 乙型肝炎疫苗 免疫应答反应 HBSAG阳性孕妇 免疫反应性 乙型肝炎病毒血清标志物 婴儿 抗-HBS阳转率 

分 类 号：R512.62[医药卫生—内科学] R512.620.3[医药卫生—临床医学]