乙型肝炎父婴传播及免疫干预的临床研究  

A clinical study on paternal-fetal transmisson of Hepatitis B virus and its immunological intervention

作　　者：王寿叶 杨文东[2] 马庆海[3] 

机构地区：[1]山东省利津县妇幼保健综合服务站,山东东营257400 [2]山东省利津县第二人民医院,山东东营257447 [3]山东省千佛山医院,山东济南250014

出　　处：《中国妇幼健康研究》2007年第1期24-26,共3页Chinese Journal of Woman and Child Health Research

摘　　要：目的 观察新生儿乙型肝炎病毒经父婴传播的感染率,探讨预防乙型肝炎父婴传播的方法。方法 2004年1月至2006年4月,选取201例丈夫血清HBV-DNA（＋）、孕妇无乙型肝炎病毒感染的病例。其中注射乙型肝炎免疫球蛋白组106例设为实验组,其中HBsAb（＋）61例、HBsAb（-）45例,均于孕20、24、28、32、36周肌肉注射乙型肝炎免疫球蛋白5次,每次200-400IU。对照组95例,HBsAb（＋）54例、HBsAb（-）41例,均未注射乙型肝炎免疫球蛋白。两组孕妇新生儿出生时均取脐带血检测HBsAg、HBV-DNA及HBsAb,观察两组新生儿乙型肝炎病毒感染率及HBsAb（＋）百分率。结果 ①实验组新生儿乙型肝炎病毒感染率25.47%（27/106）,显著低于对照组新生儿46.32%（44/95）,χ^2=9.528,P〈0.01;实验组和对照组的新生儿脐血HBsAb（＋）者分别为31.43%和20.00%,无显著性差异,χ^2=3.237,P〉0.05,但实验组的HBsAb（＋）新生儿脐血HBsAb（＋）百分率（52.46%）,显著高于对照组的HBsAb（＋）组（35.19%）,χ^2=4.136,P〈0.05,两组中的HBsAb（-）组无一例新生儿脐血HBsAb（＋）者;②实验组和对照组,HBsAb（＋）组新生儿脐血HBsAg（＋）或HBV-DNA（＋）率显著低于HBsAb（-）组,分别为χ^2=6.238,P〈0.01和χ2=6.234,P〈0.01;③实验组的HBsAb（＋）新生儿脐血HBsAg（＋）或HBV-DNA（＋）率显著低于对照组,χ^2=5.780,P〈0.05;实验组的HBsAb（-）新生儿脐血HBsAg（＋）或HBV-DNA（＋）率显著低于对照组,χ^2=4.620,P〈0.05。结论 孕期肌注乙型肝炎免疫球蛋白组可有效预防乙型肝炎病毒的父婴传播。对于丈夫血清HBV-DNA（＋）的妇女应进行主动和被动免疫的联合治疗,从而减低父婴传播发生率,提高新生儿脐血HBsAb（＋）率。Objective To investigate neonatal infection rate of HBV through paternal-fetal transmission（ P-FT）, and to explore method to prevent the neonate from HBV P-FT. Methods From January, 2004 to April, 2006, 201 pregnant women （their husbands had positive serum HBV-DNA, while themselves had no HBV infection ） were selected. 106 pregnant women were injected 200-400 IU per time of HBIG （ HBIG group） 5 times （ at the 20th weeks, the 24th weeks, the 28th weeks, the 32th weeks and the 36th weeks of gestation respectively）. Of them, 61 pregnant women had had positive HBsAb in their serum at HBIG injection, while 45 pregnant women had had no positive HBsAb in their serum at HBIG injection. 95 pregnant women were as controls, and they were not injected HBIG, of them, 54 pregnant women had had positive HBsAb in their serum, while 41 pregnant women had no positive HBsAb in their serum. At birth, the cord blood of all neonates born by all pregnant women in the two groups was taken and examined for HBsAg, HBV-DNA, and HBsAb. The neonatal HBV infection rate and percentage of positive neonatal HBsAb in the two pregnant women groups were compared. Results （1） The neonatal HBV infection rate in cord blood in the HBIG pregnant women group 25.47% （27/106） was significantly lower than that in the control pregnant women group 46.32% （44/95）,X^2 = 9. 528, P 〈 . 01. In percentage of positive neonatal HBsAb in the cord blood, there was no significant difference between the two pregnant women groups（ 31.43% , 20.00% ）, （X^2 = 3. 237 ,P 〉 0.05 ） , while the percentage of positive neonatal HBsAb in the cord blood in the positive maternal HBsAb subgroup in HBIG group（52.46% ） was significantly higher than that in the positive maternal HBsAb subgroup in the control group （35. 19% ） （X2 = 4. 136, P 〈 0.05 ）. None of neonates born by pregnant women in the two groups had positive neonatal HBsAb in their cord blood; （2）Both in the two pregnant women groups, the percentages of positive neonata

关 键 词：乙型肝炎病毒 父婴传播 免疫干预 乙型肝炎免疫球蛋白 

分 类 号：R714.251[医药卫生—妇产科学] R512.6[医药卫生—临床医学]