不同干预措施预防乙型肝炎病毒母婴传播的网络Meta分析

目的评价不同干预措施阻断乙型肝炎病毒（HBV）母婴传播的效果。 方法通过检索国内外电子数据库自建库至2016年12月31日与预防HBV母婴传播有关的随机对照试验,4种干预HBV母婴传播的措施分别为新生儿接种乙肝疫苗（HBVac）;新生儿乙肝疫苗和乙肝免疫球蛋白联合注射（HBIG + HBVac）;妊娠晚期多次注射乙肝免疫球蛋白+新生儿接种乙肝疫苗和乙肝免疫球蛋白联合注射（HBIG/HBIG + HBVac）,妊娠晚期抗病毒治疗+新生儿乙肝疫苗和乙肝免疫球蛋白联合注射（AVT/HBIG + HBVac）。按入选标准筛选后提取其中的数据进行直接、网络Meta分析,采用相对危险度（RR）和95%置信区间（CI）进行评估。 结果共纳入15篇文献,Meta分析显示,HBVac处理组显著降低了HBV母婴传播机率,RR为0.32;95%CI：0.21～0.50。HBIG + HBVac处理显著优于HBVac处理,RR = 0.37,95%CI：0.2～0.67。对高病毒载量（HBV DNA ≥ 2 × 10⁵ IU/ml）的HBV感染妊娠者,HBIG/HBIG + HBVac和AVT/HBIG + HBVac疗效显著优于HBIG + HBVac和HBVac处理（RR = 0.47,95%CI：0.29～0.75;RR = 0.31,95%CI：0.10～0.99）。 结论妊娠期抗病毒治疗联合新生儿注射HBIG对阻断HBV母婴传播效果显著,妊娠晚期注射HBIG的母婴阻断效果尚不确切。

Comparative effectiveness of prophylactic strategies for perinatal transmission of hepatitis B virus: a network Meta-analysis of randomized controlled trials

ObjectiveTo evaluate the effectiveness of interventions to block mother-to-child transmission of hepatitis B virus. MethodsReferences and randomized control trials (RCT) related to HBV prevention of mother-to-child transmission were collected by retrieving the domestic and foreign electronic databases (from database establishment to December 31st, 2016). The four measures to intervene in mother-to-child transmission of HBV were placebo/none, active immunoprophylaxis hepatitis B vaccine series starting at birth (HBVac)], passive-active immunoprophylaxis hepatitis B immunoglobulin and vaccine (HBIG + HBVac)], prenatal HBIG administration (HBIG/HBIG + HBVac), and prenatal antiviral therapy (AVT/HBIG + HBVac). According to the selection criteria, the data was extracted for direct and network Meta analysis, relative risk (RR) and 95% confidence interval (CI) were used for evaluation. ResultsTotal of 15 RCTs involving infants of HBV carrier mothers were eligible for analysis. Network meta-analysis demonstrated similar results as direct comparisons. HBVac alone significantly reduced the risk of HBV infection in infants of HBV carrier mothers (RR= 0.32, 95%CI: 0.21-0.50). Effect of the combination of immunoglobulin with vaccine (HBIG + HBVac) was better than HBVac alone (RR= 0.37, 95%CI: 0.20-0.67). In pregnant women with high viral load (HBV DNA≥2 × 10⁵IU/ml), the treatment effect of HBIG/HBIG + HBVac and AVT/HBIG + HBVac was both better than that of HBIVac and HBVac in late pregnancy (RR= 0.47, 95%CI: 0.29-0.75;RR= 0.31, 95%CI: 0.10-0.99, respectively). ConclusionsThe antiviral therapy combined with injection of HBIG was effective in blocking the transmission of HBV in pregnant women, but the effect of HBIG injection in later stages of pregnancy was not yet accurate.