HBsAg阳性母亲血清HBV DNA含量对婴儿联合免疫接种效果的影响  

Influence of serum HBV DNA level in pregnant women with HBV infection on the effect of blocking mother-to-infant transmission by passive-active immunoprophylaxis

作　　者：朱宝申[1] 李素文[1] 田红霞[1] 许剑萍[1] 李娜[1] 陈煜[2] 邹怀宾[2] 张华[2] 戴二黑[1] 

机构地区：[1]河北省石家庄市第五医院妇产科,050021 [2]首都医科大学附属北京佑安医院人工肝中心

出　　处：《中国妇幼保健》2013年第24期3903-3905,共3页Maternal and Child Health Care of China

基　　金：河北省卫生厅医学科学研究重点课题计划项目〔20100155〕

摘　　要：目的:探讨孕妇血清HBV DNA含量对乙肝疫苗与HBIG联合免疫阻断HBV母婴传播效果的影响。方法:53例HBsAg阳性且持续时间超过6个月的孕妇及其所生的53例婴儿,按照孕妇血清HBV DNA水平分3组,即>106拷贝/ml、103～106拷贝/ml和<103拷贝/ml 3组,所有婴儿于出生6 h内及30天分别注射200 IU HBIG,同时分别于出生24 h内、生后1个月及生后6个月注射3次20μg的重组酵母乙肝疫苗。检测孕妇分娩时和婴儿出生时以及1岁时静脉血HBV标志物和HBVDNA含量。结果:3组孕妇HBsAg滴度之间无显著差别(P>0.05);HBV DNA>106拷贝/ml组血清HBeAg阳性率和滴度均显著高于103～106拷贝/ml和<103拷贝/ml组(P<0.05)。所有新生儿血清HBV DNA水平均小于检测下限(1 000拷贝/mL);HBsAg阳性率为9.4%(5/53),3组新生儿HBsAg阳性率和滴度无显著差别(P>0.05);随着孕妇HBV DNA水平升高,新生儿血清HBeAg阳性率和滴度相应增高,而抗-HBe阳性率和滴度相应降低,各组间差异具有统计学意义(P<0.05)。婴儿出生12个月时,所有婴儿血清HBsAg和HBeAg检测结果均为阴性,血清HBV DNA水平均在检测下限以下。HBV DNA>106拷贝/ml组血清抗-HBs水平显著低于103～106拷贝/ml和<103拷贝/ml组,P值分别为0.021和0.011。结论:孕妇高病毒载量对乙肝母婴传播阻断成功率有一定影响。Objective:To explore the influence of serum HBV DNA level in pregnant women with HBV infection on the effect of blocking mother-to-infant transmission by passive-active immunoprophylaxis.Methods:Fifty-three pregnant women with HBV infection and their babies were divided into three groups according to serum HBV DNA level in pregnant women,including >106 copies/ml group,103~106 copies/ml group and <103 copies/ml group.All neonates adopted 200 U HBIG injection at birth and 1 month,and 20 microgramme HBV vaccine injection at birth,1 month and 6 month,respectively.Venous blood from pre-delivery pregnant women and babies at birth,12 month were collected in order to detect serum HBV markers and the level of HBV DNA.Results:There were no significant difference in level of serum HBsAg among the three groups(P>0.05).Serum HBeAg positive rate and titer in >106 copies/ml group were significantly higher than those in 103~106copies/ml group and <103 copies/ml group(P<0.05).The level of serum HBV DNA in 53 neonates was below the detecting limit(1 000 copies/ml).Serum HBsAg positive rate in 53 neonates was 9.4%(5/53),and there were no significant differences among the three groups(P>0.05).As the serum HBV DNA level was elevated,the positive rate and titer of serum HBeAg in neonates also became higher,but those of serum anti-HBe in neonates became lower gradually(P<0.05).When the babies were 1 years old,serum HBsAg and HBeAg were entirely negative,and serum HBV DNA was also below the detective limit.The level of serum anti-HBs in >106 copies/ml group was significantly lower than that in 103~106 copies/ml group and <103 copies/ml group,respectively(P=0.021;P=0.011)Conclusion:High level of serum HBV DNA in pregnant women has influence on the effective rate of blocking HBV mother-to-infant transmission.

关 键 词：肝炎病毒 乙型 疾病传播 垂直 联合免疫 病毒载量 

分 类 号：R512.62[医药卫生—内科学]