替诺福韦联合不同剂量HBIG在乙肝疫苗阻断HBV母婴传播中的效果  

Effect of tenofovir combined with different doses of HBIG in blocking hepatitis B mother-to-child transmission of hepatitis B vaccine

作　　者：张沝[1] 张薇莉[1] 赵隽[1] ZHANG Zhui;ZHANG Weili;ZHAO Juan(Department of Pediatrics,Shanghai Municipal Clinical Center for Public Health,Shanghai,201508)

机构地区：[1]上海市公共卫生临床中心儿科,201508

出　　处：《中国生育健康杂志》2022年第3期242-246,共5页Chinese Journal of Reproductive Health

摘　　要：目的分析替诺福韦联合不同剂量乙肝免疫球蛋白(HBIG)在乙肝疫苗阻断乙肝病毒(HBV)母婴传播中的效果。方法选取2013年2月~2018年3月HBV感染的妊娠妇女[高载量(HBV DNA>1×10^(6)IU/mL)]1000例,分为乙肝免疫球蛋白100 IU组(替诺福韦300 mg/d+新生儿出生后12 h内、1月肌注100 IU HBIG+0、1、6月注射10μg乙肝疫苗)和乙肝免疫球蛋白200 IU组(替诺福韦300 mg/d+新生儿出生后12 h内、1月肌注200 IU HBIG+0、1、6月注射10μg乙肝疫苗)。比较两组基线资料、新生儿情况、抗-HBs水平、母婴阻断效果、安全性、随访24个月情况。结果基线资料及新生儿情况在二组中的比较,均差异无统计学意义(P>0.05)。乙肝免疫球蛋白200 IU组出生1月、7月的抗-HBs水平[依次(295.8±42.9)mIU/mL、(764.1±146.3)mIU/mL]高于乙肝免疫球蛋白100 IU组[依次(250.9±33.7)mIU/mL、(737.2±152.1)mIU/mL],差异有统计学意义(P<0.05)。乙肝免疫球蛋白200 IU组阻断失败率(3.6%)低于乙肝免疫球蛋白100 IU组(6.6%),抗-HBs阳性率(96.4%)高于乙肝免疫球蛋白100 IU组(93.4%),差异有统计学意义(P<0.05)。24个月随访中,乙肝免疫球蛋白100 IU组失访9例(1.8%),乙肝免疫球蛋白200 IU组失访11例(2.2%);HBV DNA阳性、抗-HBs阳性在二组中的比较,差异无统计学意义(P>0.05)。二组替诺福韦不良反应比较差异无统计学意义(P>0.05);新生儿无不良反应。结论替诺福韦联合200 IU剂量HBIG在乙肝疫苗阻断HBV母婴传播中有助于短期内提高免疫保护及阻断效果,而长期效果与联合100 IU剂量HBIG相当,两种方案均安全可靠。Objective To analyze the effect of tenofovir combined with different doses of hepatitis B immunoglobulin(HBIG)in blocking the mother-to-child transmission of hepatitis B virus(HBV)by hepatitis B vaccine.Methods A total of 1000 pregnant women with HBV infection[high load(HBV DNA>1×10^(6)IU/mL)]from February 2013 to March 2018 were selected and divided into the hepatitis B immunoglobulin 100 IU group(tenofovir 300 mg/mL)d+neonates were intramuscularly injected with 100 IU HBIG within 12 hours after birth and injected with 10μg hepatitis B vaccine at 0,1,and 6 months)and hepatitis B immunoglobulin 200 IU group(tenofovir 300 mg/d+neonates within 12 hours after birth,Intramuscular injection of 200 IU HBIG in January+injection of 10μg hepatitis B vaccine in 0,1,and 6 months).Baseline data,neonatal conditions,anti-HBs levels,mother-infant blocking effect,safety,and 24-month follow-up were compared between the two groups.Results There was no significant difference in baseline data and neonatal conditions between the two groups(P>0.05).The levels of anti-HBs in the 200 IU HBIG group were higher than those in the HBIG 100 IU group[in sequence(295.8±42.9)mIU/mL,(764.1±146.3)mIU/mL]33.7)mIU/mL,(737.2±152.1)mIU/mL],the difference was statistically significant(P<0.05).The blocking failure rate(3.6%)of the HBV 200 IU group was lower than that of the 100 IU HBV group(6.6%),and the positive rate of anti-HBs(96.4%)was higher than that of the 100 IU HBV group(93.4%).There was statistical significance(P<0.05).During the 24-month follow-up,9 cases(1.8%)in the hepatitis B immunoglobulin 100IU group were lost to follow-up,and 11 cases(2.2%)in the hepatitis B immunoglobulin 200 IU group were lost to follow-up;the comparison of HBV DNA positive and anti-HBs positive in the two groups,the difference was not statistically significant(P>0.05).There was no significant difference in the adverse reactions of tenofovir between the two groups(P>0.05);there were no adverse reactions in neonates.Conclusion Tenofovir combined with a 200 IU do

关 键 词：乙型肝炎病毒 替诺福韦 HBIG 乙肝疫苗 母婴传播 

分 类 号：R17[医药卫生—妇幼卫生保健] R18[医药卫生—公共卫生与预防医学]