乙型肝炎疫苗和乙肝免疫球蛋白阻断乙肝病毒母婴传播的效果

目的:调查实际应用中免疫预防阻断乙型肝炎病毒(HBV)母婴传播的效果,观察孕期注射乙肝免疫球蛋白(HBIG)能否减少HBV母婴感染。方法:对2006年1月至2010年12月在镇江市妇幼保健院分娩的224例乙肝表面抗原(HBsAg)阳性母亲以及250例儿童,结合住院病历,进行回顾性调查,记录母亲孕期HBIG使用情况、子女出生后HBIG和乙型肝炎疫苗接种资料,并采血检测HBV血清标志物及谷丙转氨酶(ALT)。其中69例儿童出生后免疫预防前采外周血检测HBV血清标志物。结果:250例HBsAg阳性孕妇的子女随访时年龄(3.3±1.6)岁,出生时检测HBV标志物的69例中,4例HB-sAg阳性,其中2例随访时HBsAg仍阳性,乙型肝炎e抗原(HBeAg)也阳性,说明慢性感染,另外2例HBsAg转阴;1例出生时HBsAg阴性,但随访时转为阳性。另1例出生时未检测,随访时HBsAg阳性。因此共4例(1.6%)慢性感染HBV,其母亲均为HBeAg阳性。4例感染儿童中,2例出生时未注射HBIG,且未正规接种疫苗。随访的224例母亲中,215例明确孕期使用HBIG的情况;76例子女的母亲孕期注射了HBIG,1例(1.3%)HBsAg阳性,142例子女的139例母亲孕期未使用HBIG,3例(2.1%)HBsAg阳性(P>0.05)。结论:HBsAg阳性孕妇的子女经正规免疫预防后,HBV母婴阻断效果良好,部分预防失败是由于未实施正规预防。新生儿出生时HBV血清标志物不能作为诊断是否感染HBV的指标。孕晚期使用HBIG对阻断母婴感染无效。

Protective effect of hepatitis B vaccine and hepatitis B immunoglobulin on infants against mother-to-infant transmission of hepatitis B virus

Objective:To investigate the protective effect of hepatitis B vaccine and hepatitis B immunoglobulin(HBIG) in routine application on infants against mother-to-infant transmission(MTIT) of hepatitis B virus(HBV),and clarify whether HBIG in pregnancy women may reduce MTIT of HBV.Methods:Totally 250 children born to HBV-infected mothers in Zhenjiang Maternal and Child Health Hospital,during Jan.2006 to Dec.2010,were enrolled.Of the 250 newborn infants,69 were tested for HBV markers in peripheral blood before immunoprophylaxis.The 250 infants and their 224 mothers were followed-up and screened for HBV markers and ALT.Information including HBIG administration during pregnancy,hepatitis B vaccine and HBIG administration in each infant was collected.Results:The 250 children of HBsAg-positive mothers were 1-6 years of age(mean,3.3±1.6).Of the 69 children who were tested for HBV markers at birth,4 were HBsAg-positive.During the follow-up,two children were still HBsAg-positive and also HBeAg-positive,indicating chronic HBV infection;the remaining two children became HBsAg-negative.Moreover,one HBsAg-negative infant and another one with unknown HBV serological status at birth were HBsAg-positive during follow-up.Thus,4(1.6%) were chronically infected with HBV;their mothers were all HBeAg-positive.Of the four infected children,two were not injected HBIG and not immunized with hepatitis B vaccine based on the standard schedule.Of the 224 mothers,215 were recorded with HBIG administration during pregnancy.The HBsAg-positive rate in 76 children of the 76 mothers who were treated with HBIG during pregnancy was 1.3%,whereas that in 142 children of the 139 women who were not treated with HBIG was 2.1%(P>0.05).Conclusion:The protective effect of routine immunoprophylaxis against MTIT of HBV is definite,and the failure in some children is due to the inappropriate implementation of measures.Detection of HBsAg in newborn infants is not suitable to define MTIT of HBV,which can not be reduced by HBIG administration in later pregnancy.