免疫阻断乙型肝炎病毒母婴传播多中心研究  

A multi-center study on the efficacy of immunoprophylaxis for mother-to-infant transmission of hepatitis B virus in multi-centers

作　　者：张磊[1,2] 桂希恩[1] 汪波 贺兴玲 张玲[5] 朱凤仪 李莉 叶萍 黎逢良 周云 刘小英 

机构地区：[1]武汉大学中南医院感染科,湖北武汉430071 [2]青岛市立医院感染科,山东青岛266000 [3]太原市传染病院妇产科,山西太原030012 [4]宜城市人民医院妇产科,湖北宜城441400 [5]黄冈市妇幼保健院妇产科,湖北黄冈438000 [6]台山市妇幼保健院保健科,广东台山529200 [7]伊宁市妇幼保健院艾滋病科,新疆伊宁835000 [8]大冶市妇幼保健院保健科,湖北大冶435100 [9]通城县妇幼保健院外科,湖北通城437400 [10]当阳市妇幼保健院新生儿科,湖北当阳444100 [11]孝感市孝南区妇幼保健院保健科,湖北孝感432100

出　　处：《中国实用妇科与产科杂志》2015年第1期65-69,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：香港择善基金(03235807)

摘　　要：目的探讨孕产妇乙型肝炎表面抗原（HBs Ag）阳性率及乙型肝炎病毒（HBV）母婴传播阻断的效果。方法2008-2012年,通过多中心队列研究,对湖北省、山西省、广东省、新疆维吾尔自治区等地的孕产妇进行HBs Ag筛查;对上述地区部分医院入院分娩的HBs Ag阳性母亲及8-12个月龄婴儿进行随访观察,所有标本检测乙型肝炎血清标志物（HBs Ag,HBs Ab,HBe Ag,HBe Ab,HBc Ab）,部分标本检测HBV DNA。结果筛查孕妇82214例,HBs Ag阳性4924例,阳性率6.0%。随访HBs Ag阳性母亲及8-12个月龄婴儿1371对,婴儿免疫阻断失败率3.1%（42/1371）,HBs Ag及HBe Ag双阳性母亲婴儿的免疫阻断失败率为8.2%。免疫阻断失败的婴儿其母亲均为HBe Ag阳性且HBV DNA≥6 log10copies/m L。HBe Ag阳性母亲孕期注射乙型肝炎免疫球蛋白（hepatitis B immune globulin,HBIG）及未注射HBIG组,其婴儿免疫阻断失败率差异无统计学意义（8.8%vs.8.1%,P=0.807）。结论多中心调查显示目前孕产妇HBs Ag阳性率6.0%,HBV母婴阻断失败率3.1%。HBs Ag及HBe Ag双阳性且HBV DNA≥6 log10 copies/m L的孕妇应为母婴阻断的重点人群。孕妇孕期注射HBIG不能提高HBV母婴阻断效果。Objective To evaluate the current positive rete of HBsAg among pregnant women and explore more effective interruption measures for mother-to-infant transmission.Methods From 2008 to 2012, pregnant women were screened for HBsAg in multi-centers （Province of Hubei, Shanxi and Guangdong and Xinjiang Uygur Autonomous Region）. HBsAg positive mothers before labour and their infants aged 8-12 months in some hospitals among those areas were determined for HBV markers （HBsAg,HBsAb, HBeAg, HBeAb, HBcAb） and some of them also had HBV DNA tests.Results HBsAg positive rate of pregnant women was 6.0% （4924/82214）. Infants＇ immunoprophylaxis failure rate was 3.1% （42/1371） and it was 8.2% among infants of HBsAg and HBcAg positive mothers. Immunoprophylaxis failure infants were all born to mothers of HBeAg positive and HBV DNA≥6 log10 copies/mL. Among infants of HBeAg positive mothers, immunoprophylaxis failure rates had no significant difference between mother with hepatitis B immune globulin （HBIG） and without HBIG （8.8% vs. 8.1%, P=0.807）.Conclusions These findings demonstrate that pregnant women are still with high HBsAg prevalence （6.0%） in China. HBV mother-to-infant transmission （3.1%） still occurs after active-passive immunization. Pregnant women of HB- sAg and HBeAg positive and HBV DNA≥6 log10 copies/mL are the major population for preventing HBV mother-to-infant transmission. HBIG administered dur- ing late pregnancy to HBsAg-positive mothers does not reduce the risk of mother-to-child transmission of HBV.

关 键 词：乙型肝炎病毒 孕产妇 乙型肝炎免疫球蛋白 母婴传播 免疫阻断 

分 类 号：R714.251[医药卫生—妇产科学]