乙肝免疫球蛋白与乙肝病毒疫苗联合应用阻断乙肝母婴传播的Meta分析  

Meta Analysis of the Effect of Hepatitis B Immunoglobulin Combined with Hepatitis B Vaccines on Interrupting Intrauterine Transmission of HBV

作　　者：黎健[1] 李燕婷[1] 顾宝柯[1] 吴寰宇[1] 袁政安[1] 

机构地区：[1]上海市疾病预防控制中心急性传染病防治科,上海200336

出　　处：《环境与职业医学》2010年第2期78-82,共5页Journal of Environmental and Occupational Medicine

基　　金：上海市公共卫生重点学科建设计划资助项目(08GWZX0101)

摘　　要：[目的]综合评价孕晚期注射乙肝免疫球蛋白联合新生儿注射乙肝免疫球蛋白及乙肝病毒疫苗阻断乙肝病毒母婴传播的有效性,为制定重点人群的乙肝免疫策略提供循证依据。[方法]应用计算机检索相关文献,实验组干预措施为孕晚期注射乙肝免疫球蛋白,新生儿注射乙肝免疫球蛋白和乙肝病毒疫苗;对照组干预措施仅为新生儿注射乙肝病毒疫苗。对符合纳入标准的8项随机对照研究,采用固定和随机效应模型进行Meta分析。[结果]各纳入文献的发表偏倚较小。Meta分析显示实验组母婴传播率（6.01%）低于对照组（16.37%）,χ^2=7.02,P〈0.001;合并RR为0.37,95%可信区间为0.28-0.48,敏感性分析提示模型稳定性较好。亚组分析显示无论对于单纯HBsAg阳性还是HBsAg和HBeAg双阳性的孕妇;或者不管是以新生儿出生24h内乙肝感染标志阳性或是以出生后12个月乙肝感染标志阳性为标准,实验组的母婴传播率均低于对照组（P〈0.05）。[结论]孕晚期注射乙肝免疫球蛋白联合新生儿注射乙肝免疫球蛋白及乙肝病毒疫苗能有效地阻断乙肝病毒的母婴传播。[Objective] To evaluate systematically the validity of injection of hepatitis B immunoglobulin（HBIG）during the third trimester of pregnancy combined with injection of HBIG and hepatitis B vaccines for neonates on interrupting intrauterine transmission of HBV,and to provide the evidence-based basis for establishing the strategy of HBV vaccination for key population.[Methods] Related literatures were searched using computer.Altogether 66 related papers had been retrieved,but only 8 of them were included into this analysis,in which the intervention of experimental group was treating with injection of HBIG during the third trimester of pregnancy and combined with injection of HBIG and hepatitis B vaccine for their neonates,whereas the intervention of control group was treating with injection of hepatitis B vaccine only for neonates.Fixed and random effect models were applied to finish the Meta analysis for the 8 randomized control studies which conformed to the included criterion.[Results] The publishing error of these included studies was comparatively small.The results of Meta analysis showed the rate of intrauterine transmission of experimental group（6.01%）was lower than that of control group（16.37%）with χ^2 =7.02（P〈 0.001）and the total RR =0.37（95%CI：0.28-0.48）.The sensitivity analysis suggested the stability of the model was good.The analysis of subcategory showed,whether for those simply with HBsAg positive or those with both HBsAg and HBeAg positive,either,whether regarding the sign of HBV infection positive within 24 hours after birth as standard or regarding the sign of HBV infection positive 12 months after birth as standard,the rates of intrauterine transmission of experimental group were both lower than those of control group with statistical significance（P 〈0.05）.[Conclusion] Injection of HBIG during the third trimester of pregnancy combined with injection of HBIG and hepatitis B vaccines for their neonates could effectively interrupt the intrauterine transmission of HBV.

关 键 词：乙肝免疫球蛋白 乙肝病毒疫苗 母婴传播 META分析 

分 类 号：R183[医药卫生—流行病学]