乙型肝炎免疫球蛋白聯(lián)合乙肝疫苗治療對(duì)阻斷乙型肝炎病毒母嬰傳播療效和安全性研究

李鳳娥

【摘要】 目的：探究乙型肝炎免疫球蛋白（HBIG）聯(lián)合乙肝疫苗對(duì)阻斷乙型肝炎病毒（HBV）母嬰傳播的療效和安全性。方法：選取2015年2月-2017年2月本院收治的妊娠合并乙型肝炎患者78例。按照住院號(hào)尾數(shù)單雙號(hào)將其分成觀察組（HBIG+乙肝疫苗）與對(duì)照組（乙肝疫苗），各39例。比較兩組母嬰傳播指標(biāo)、新生兒出生時(shí)的發(fā)育情況。結(jié)果：觀察組乙型肝炎病毒表面抗原（HBsAg）陽性率、HBV-DNA陽性率、阻斷傳播失敗率、宮內(nèi)感染率均低于對(duì)照組，乙型肝炎病毒表面抗體（HBsAb）陽性率高于對(duì)照組，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）;兩組新生兒性別、身長、體重、頭圍及新生兒窒息發(fā)生率比較，差異均無統(tǒng)計(jì)學(xué)意義（P>0.05），但觀察組新生兒Apgar評(píng)分高于對(duì)照組（P<0.05）。結(jié)論：HBIG聯(lián)合乙肝疫苗應(yīng)用于阻斷HBV母嬰傳播，加強(qiáng)新生兒免疫，減少了母嬰垂直傳播（宮內(nèi)感染）的發(fā)生率，減少了乙型肝炎傳播，此方法值得應(yīng)用與推廣。

【關(guān)鍵詞】 乙型肝炎病毒; 母嬰傳播; 阻斷; 乙型肝炎免疫球蛋白

【Abstract】 Objective：To study the efficacy and safety of hepatitis B immune-globulin（HBIG）plus hepatitis B vaccine for interrupting the mother-infant transmission of hepatitis B virus（HBV）.Method：A total of 78 pregnant women with hepatitis B admitted to our hospital from February 2015 to February 2017 were selected.According to the final number of hospitalization，they were divided into observation group（HBIG+hepatitis B vaccine）and control group（hepatitis B vaccine），39 cases in each group.The maternal-infant transmission indicators and neonatal development between two groups were compared.Result：The positive rate of hepatitis B virus surface antigen（HBsAg），HBV-DNA，failure rate of blocking transmission，intrauterine infection rate and chronic infection rate in observation group were lower than those of control group，and the positive rate of hepatitis B virus surface antibody（HBsAb）was higher than that of control group，the differences were statistically significant（P<0.05）.The sex，length，weight，head circumference and incidence of neonatal asphyxia in two groups were compared，the differences were not statistically significant（P>0.05），but the Apgar score of newborns in observation group was higher than that of control group（P<0.05）.Conclusion：HBIG combined with hepatitis B vaccine is used to block mother-infant transmission of HBV，strengthen the immunization of newborns，reduce the incidence of mother-infant transmission（intrauterine infection），and reduce the transmission of hepatitis B，this method is worthy of application and promotion.

【Key words】 Hepatitis B virus; Mother-infant transmission; Interruption; Hepatitis B immune-globulinFirst-authors address：Guangming District Group Hospital，Shenzhen 518107，China

doi：10.3969/j.issn.1674-4985.2019.15.016

乙型肝炎是嚴(yán)重危害人類健康的主要傳染病，我國是乙型肝炎高發(fā)區(qū)，全世界大約有3億例乙型肝炎病毒表面抗原（HBsAg）陽性攜帶者，而我國約有1.2億例[1-2]。乙型肝炎病毒（HBV）可經(jīng)多種渠道傳播，在我國HBV主要通過垂直傳播或者嬰幼兒早期暴露于HBV所致，其中又以產(chǎn)前傳播為主，產(chǎn)前傳播可分為經(jīng)胎盤傳播和經(jīng)生殖細(xì)胞傳播[3-4]。HBV母嬰間傳播主要途徑有：宮內(nèi)感染（通過胎盤感染胎兒）、生產(chǎn)時(shí)感染（生產(chǎn)時(shí)接觸母血和羊水）、產(chǎn)后感染（密切接觸、乳汁傳播）[5]。而宮內(nèi)感染是HBV母嬰間傳播的主要途徑。本研究采用乙型肝炎免疫球蛋白（HBIG）治療，為臨床治療方案提供借鑒，現(xiàn)報(bào)道如下。