HBsAg阳性母亲血清HBeAg对婴儿联合免疫接种效果的影响  

The influence of serum HBeAg 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] 尹华春[1] 钱静[1] 张雅静[1] 安军霞 陈煜[2] 邹怀宾[2] 张华[2] 戴二黑[1] 

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

出　　处：《现代预防医学》2013年第21期3955-3957,共3页Modern Preventive Medicine

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：目的探讨感染HBV孕妇血清HBeAg状况对乙肝疫苗与乙型肝炎免疫球蛋白(HBIG)联合免疫阻断HBV母婴传播效果的影响。方法 51例感染HBV孕妇及其所生的51例婴儿,按照分娩时孕妇血清HBeAg状况分为两组,即HBeAg阳性组与阴性组。所有婴儿于出生6 h内及30 d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HBV DNA含量。结果 HBeAg阳性组孕妇血清HBV DNA阳性率和含量均高于阴性组(P=0.000)。51例新生儿血清HBV DNA水平均小于检测下限(1 000拷贝/ml);HBsAg阳性率为7.8%(4/51),两组新生儿HBsAg阳性率和滴度差异无统计学意义(P﹥0.05);孕妇血清HBeAg阳性组新生儿血清HBeAg阳性率及滴度均高于阴性组,而血清抗-HBe阳性率及滴度均低于阴性组(P=0.000)。出生12个月时,所有51例婴儿血清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。HBeAg阴性组和阳性组婴儿血清抗-HBs阳性率分别为100.0%(25/25)和96.2%(25/26)(P﹥0.05),HBeAg阴性组婴儿血清抗-HBs水平高于阳性组(P=0.042)。结论孕妇分娩时血清HBeAg状态对乙肝母婴阻断成功率没有影响,但是对婴儿体内保护性抗体的产生有一定影响。OBJECTIVE To explore the influence of serum HBeAg of pregnant women with HBV infection on the effect of blocking mother-to-infant transmission by passive-active immunoprophylaxis. METHODS Fifty-one pregnant women with HBV infection and their babies were divided into two groups according to the status of serum HBeAg of pregnant women, i.e. serum HBeAg positive group and negative group. All neonates received 200IU HBIG injection at birth of 6 hours and 1 month, and 20 microgramme HBV vaccine injection at birth of 24 hours, 1 month and 6 months, respectively. Venous blood from pre-delivery pregnant women and babies at birth, and 12 months were collected in order to detect serum HBV markers and the level of HBV DNA. RESULTS The positive rate and titer of serum HBV DNA in HBeAg positive group were significantly higher than those in HBeAg negative group （P = 0.000）. The levels of serum HBV DNA in 51 neonates were below the detecting limit （1 000 copies/ml）. The positive rate of serum HBsAg in 51 neonates was 7.8% （4/51）, and there was no significant difference between the two groups （P 〉 0.05）. Serum HBeAg positive rate and titer of neonates in HBeAg positive group were significantly higher than those in HBeAg negative group, but those of serum anti-HBe in the former were significantly lower than those in the latter （P = 0.000）. When the babies were 1 year old, serum HBsAg and HBeAg were entirely negative, and serum HBV DNA was also below the detective limit. The positive rate of serum anti＇HBs in HBeAg negative group and positive group was 100.0% （25/25） and 96.2% （25/26）, respectively （P 〉 0.05）. The level of serum anti-HBs in HBeAg negative group was significantly higher than that in HBeAg positive group （P = 0.042）. CONCLUSION The status of serum HBeAg in pregnant women has no influence on the effective rate of blocking HBV mother-to-infant transmission, but affects the level of anti-HBs in infants.

关 键 词：肝炎病毒 乙型 疾病传播 垂直 联合免疫 

分 类 号：R512.62[医药卫生—内科学]