不同母婴阻断方式对新生儿乙型肝炎病毒母婴传播的影响

目的:观察不同母婴阻断方式对HBV阻断效果的影响。方法:2006年1月～2010年1月在承德医学院附属医院进行产前检查的HBV-DNA阳性的孕妇共85例,随机分为3组。其中阻断Ⅰ组30例,只应用HBIG;阻断Ⅱ组30例,孕妇自妊娠28周开始口服拉米夫定,100 mg/天,直至产后30天,新生儿出生后按与阻断Ⅰ组同样的方法注射HBIG;对照组25例,在妊娠末期不采取措施。3组新生儿出生24 h内均注射乙肝疫苗。3组新生儿在出生24 h、7月和12月不同时间分别检测血清HBV-marker和HBV-DNA。结果:阻断I组和II组24 h、7月龄和12月龄HBsAg阳性率低于对照组(P<0.05);阻断I组和II组7月龄和12月龄HbsAb阳性率高于对照组(P<0.05);3组血清HbsAb定量,阻断I组、阻断II组7月龄、12月龄均高于对照组(P<0.05)。结论:孕晚期采用注射HBIG和应用拉米夫定两种不同母婴阻断方式均能够有效阻断HBV母婴传播,降低胎儿的感染率。

Effects of different maternal and child block modes on mother-to-child transmission of neonatal hepatitis B virus

Objective:To observe the effects of different maternal and child block modes on the effectiveness of hepatitis B virus(HBV) block. Methods:85 pregnant women with positive HBV-DNA who received prenatal examination in affiliated hospital of Chengde medical college from January 2006 to January 2010 were selected and divided into three groups randomly: 30 cases in block Ⅰ group were treated with HBIG;30 cases in block Ⅱ group were treated with oral administration of lamivudine from the 28th gestational weeks to 30 days after delivery,100 mg per day,the neonates were treated with HBIG;25 cases in control group didn't receive any treatment in the end of pregnancy.The neonates in the three groups were treated with injection of hepatitis B vaccine within 24 hours after birth.The serum HBV-marker and HBV-DNA of the neonates in the three groups were detected at 24 hours,7 months and 12 months after birth. Results:The positive rates of HBsAg in block Ⅰ group and block Ⅱ group at 24 hours,7 months and 12 months after birth were significantly lower than those in control group(P<0.05);the positive rates of HBsAb in block Ⅰ group and block Ⅱ group at 7 months and 12 months after birth were significantly higher than those in control group(P<0.05);the quantitation of HBsAb in block Ⅰ group and block Ⅱ group at 7 months and 12 months after birth were significantly higher than those in control group(P<0.05). Conclusion:The two kinds of maternal and child block modes(injection of HBIG and oral administration of lamivudine) both can block mother-to-child transmission of HBV effectively and reduce the infection rate of fetuses.