母婴乙肝阻断效果与母体乙肝病毒载量及感染模式的对比研究  

Comparative Study on Mother-infant Hepatitis B Blocking Effect and Maternal Hepatitis B Viral Load and Infection Model

作　　者：王义刚 陈航华 黄素艳[1] 张栋武 余健全 WANG Yigang;CHEN Hanghua;HUANG Suyan;ZHANG Dongwu;YU Jianquan(Foshan City Gaoming District People’s Hospital,Gaoming Hospital Affiliated to Guangdong Medical University,Foshan 528500,China)

机构地区：[1]广东省佛山市高明区人民医院广东医科大学附属高明医院

出　　处：《中国医学创新》2019年第34期130-134,共5页Medical Innovation of China

基　　金：佛山市医学类科技攻关项目(2017AB001114);佛山市十三五医学重点专科培育项目(FSZDZK135058);高明区十三五医学重点专科资助项目(GMGSPZD13504)

摘　　要：目的:分析母体乙肝感染模式及病毒载量与母婴乙肝阻断效果的关联性,为母婴乙肝阻断方法提供决策依据。方法:以2015年12月-2017年12月到本院待产的HBsAg阳性孕妇168例为研究对象,采用酶联免疫吸附试验方法测定孕妇乙肝病毒感染模式,将乙肝表面抗原(HBsAg)、E抗原(HBeAg)及核心抗体(HBcAb)同时阳性者(91例)按意愿分为两组,其中48例孕妇自愿采纳医生建议分别于孕28、32、36周接受重组乙肝免疫球蛋白200 IU注射进行早期干预的阻断模式(研究A组);另外43例为研究B组,正常妊娠不接受乙肝免疫球蛋白注射。其余77例感染模式为对照组。所有新生儿均采用接种3×10μg乙肝疫苗(HepB)和200 IU乙肝免疫球蛋白(HBIG)的阻断模式,运用全自动实时荧光定量PCR测定各组母体HBV DNA载量,分别于新生儿出生时、6月龄及12月龄时检测其HBsAg和HBV DNA载量,比较母体乙肝感染模式、病毒载量及阻断方法与新生儿乙肝阻断效果的关联性。结果:研究A组干预前HBV DNA载量显著高于对照组(P<0.05),干预后HBV DNA载量与对照组比较差异无统计学意义(P>0.05)。研究A组母婴阻断成功率为97.9%(47/48)与对照组的97.4%(75/77)比较,差异无统计学意义(P>0.05)。研究B组HBV DNA载量显著高于对照组及研究A组(P<0.05),母婴阻断成功率为88.4%(38/43),与研究A组及对照组比较差异均有统计学意义(P<0.05)。8例阻断失败新生儿其母体HBV DNA载量显著高于阻断成功患儿(P<0.05)。孕妇乙肝感染模式与母婴乙肝阻断效果关系密切(r=0.702,P<0.05),未干预高病毒载量母体母婴阻断面临失败风险。母体病毒载量与阻断效果明显负相关(r=-0.635,P<0.05)。结论:孕晚期肌注重组乙肝免疫球蛋白能够显著降低孕妇HBV病毒载量,孕妇注射HepB及新生儿接种3×10μg乙肝疫苗和200 IU乙肝免疫球蛋白注射阻断乙肝母婴传播的效果确切且优于单纯新生儿阻断模式。Objective: To analyze the relationship between maternal hepatitis B infection model and viral load and mother-infant hepatitis B blocking effect, to provide decision-making basis for mother-infant hepatitis B blocking methods. Method: A total of 168 cases of HBsAg-positive pregnant women in our hospital from December 2015 to December 2017 were enrolled in the study. The hepatitis B virus infection model was determined by enzyme-linked immunosorbent assay(ELISA). Patients with positive hepatitis B surface antigen(HBsAg), E antigen(HBeAg) and core antibody(HBcAb)(the study A group, n=91) were voluntarily divided into two groups, of which 48 pregnant women voluntarily adopted doctor’s advice to receive Recombinant Hepatitis B Immunoglobulin 200 IU injection at 28, 32 and 36 weeks, respectively to get blocking mode for early intervention;another 43 cases(the study group B) were normal pregnancy, and did not receive Hepatitis B Immunoglobulin Injection. The remaining 77 cases with infection models were in the control group. All newborns were vaccinated with 3×10 μg Hepatitis B Vaccine(HepB) and 200 IU Hepatitis B Immunoglobulin(HBIG). Maternal HBV DNA load was determined by automatic real-time fluorescent quantitative PCR and HBsAg and HBV DNA loads in newborns were detected at birth, 6 months and 12 months of age. Finally, the correlation between maternal hepatitis B infection model, viral load and blocking method and neonatal hepatitis B blocking effect were compared. Result: Compared with the control group, the HBV DNA load before intervention of the study A group was significantly higher than that of the control group(P<0.05). There was no significant difference in HBV DNA load after intervention between the study A group and the control group(P>0.05). There was no significant difference in the success rate of maternal and infant blockade in the study A group(97.9%, 47/48) and the control group(97.4%, 75/77)(P>0.05). The HBV DNA load in the study B group was significantly higher than that in the study A group(

关 键 词：乙型肝炎 母婴阻断 病毒载量 免疫球蛋白 

分 类 号：R714.251[医药卫生—妇产科学]