乙型肝炎病毒母婴传播阻断措施效果的回顾性总结  

Study on the efficacy of interruption of maternal-infantile transmission of HBV of 1269

作　　者：韩国荣[1] 赵伟[1] 余敏敏[1] 唐讯[1] 沈玲[1] 岳欣[1] 

机构地区：[1]东南大学附属南京市第二医院妇产科,江苏南京210003

出　　处：《世界感染杂志》2006年第1期26-29,共4页World Journal of Infection

基　　金：东南大学基金资助课恿（编号2000-087）

摘　　要：目的探讨对乙型肝炎表面抗原（HBsAg）阳性母亲实施阻断母婴传播的最佳方案，探索免疫失败的原因及对策．方法总结：1985年至2004年3680例HBsAg（＋）母亲分娩新生儿实施母婴阻断后的血清乙肝病毒标志物资料，根据不同的阻断方案分成5组：血源疫苗组（第1组）、血源联合组（第2组）、基因疫苗组（第3组）、基因联合组（第4组）、宫内阻断组（第5组）。其中共1269例婴儿随访至12个月龄．观察，比较各组婴儿出生时及1、6、12个月龄时的HBsAg、HBsAb的阳性率。结果第5组42个月龄时HBsAg阳性率仅为3．86％，与第1、3组比较，P〈0．01，与第2、4组比较，P〈0．05；保护率达96.14％；与前4组比较，P〈0．05。第4、5组比较，出生时HBsAb检出率分别为8．33％、82．32％，P〈0.01；宫内感染率分别为51．67％、31．91％，P〈0．05；慢性感染率为26．67％、15．04％，P〈0．05；免疫失败率为19．35％、12．10％，P〈0．05。第5组12月龄时HBsAb平均滴度高于第4组，P〈0．05。第2、4组12个月龄时HBsAg的阳性率分别低于第1、3组，HBsAb阳性率高于第1、3组，P〈0．05。双阳组、单阳组母亲分娩新生儿12个月龄时HBsAg的阳性率分别为20．10％、7．81％，P〈0．01。结论5种阻断方集中，第5组即宫内阻断组的保护率最高，HBV宫内感染率最低；联合免疫效果优于单疫苗组。乙型肝炎病毒的母婴传播与母亲HBeAg或HBV DNA阳性显著相关。免疫失败的重要原因是宫内感染，产前多次注射HBIG可减少HBV宫感染。Objective To investigate the best protective method of maternal-infantile transmission of HBV and explore the causes and strategies of immunization failure. Methods From 1985 to 2004, 3680 infants from HB.sAg （＋）mother received various protective methods and were asked to have blood samples collected at 0, 1, 6, 12 month after birth respectively. They were divided into 5 groups according to 5 different protective methods as follows： plasma-derived HBV vaccine （the first） group and combined HBIG （the second） group, yeast recombinant HBV vaccine （the third） group arid combined HBIG （the 4th） group, intrauterine interruption （the 5th） group.1269 of 3680 cases were followed up to 12 months of age. We observed and compared their HBsAg, Anti-HBs positive rate which was detected by ELIAS （Enzyme Linked Immunoassay） and found the relationship with their mothers, HBeAg and HBV DNA positive rate. Result The positive rate of HBsAg （3.86%） of the 5th group Was lower while the positive rate of Anti-HBs （96.14%） was higher than that of the other 4 groups. Compared with the first and the third group, the second and the 4th group, thetwo positive rates also showed significant difference, P〈0.01 and P〈0.05 respectively. The detection rate of anti- HBs in newborns and anti-HBs level in 12 month were significantly higher in the 5thgroup than that in the4th group. The incidence of intrauterine HBV infection and the rate of chronicity HBV infection in the infants of the 5th group were much lower than that of the 4th group respectively （31.91%, 51.67%,15.04%, 26.67%）, The protective efficacy of the second and 4th group was better than that of the fwst and third group. P〈0,05. The positive rate of HBsAg of infants from both HBsAg and HBeAg positive mothers was20.10%, otherwise it was 7.81% while from only HBsAg positive mothers. P〈0.01. Conclusion Among the 5 methods, the 5th group was the most effective, vaccine combining HBIG was prior to vaccine only. The maternal-infantile transmi

关 键 词：乙型肝炎病毒 传播 接种 婴儿 官内感染 

分 类 号：R373.2[医药卫生—病原生物学]