乙型肝炎免疫球蛋白联合乙肝疫苗治疗对阻断乙型肝炎病毒母婴传播疗效和安全性研究

李凤娥

【摘要】 目的：探究乙型肝炎免疫球蛋白（HBIG）联合乙肝疫苗对阻断乙型肝炎病毒（HBV）母婴传播的疗效和安全性。方法：选取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。按照住院号尾数单双号将其分成观察组（HBIG+乙肝疫苗）与对照组（乙肝疫苗），各39例。比较两组母婴传播指标、新生儿出生时的发育情况。结果：观察组乙型肝炎病毒表面抗原（HBsAg）阳性率、HBV-DNA阳性率、阻断传播失败率、宫内感染率均低于对照组，乙型肝炎病毒表面抗体（HBsAb）阳性率高于对照组，差异均有统计学意义（P<0.05）;两组新生儿性别、身长、体重、头围及新生儿窒息发生率比较，差异均无统计学意义（P>0.05），但观察组新生儿Apgar评分高于对照组（P<0.05）。结论：HBIG联合乙肝疫苗应用于阻断HBV母婴传播，加强新生儿免疫，减少了母婴垂直传播（宫内感染）的发生率，减少了乙型肝炎传播，此方法值得应用与推广。

【关键词】 乙型肝炎病毒; 母婴传播; 阻断; 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

乙型肝炎是嚴重危害人类健康的主要传染病，我国是乙型肝炎高发区，全世界大约有3亿例乙型肝炎病毒表面抗原（HBsAg）阳性携带者，而我国约有1.2亿例[1-2]。乙型肝炎病毒（HBV）可经多种渠道传播，在我国HBV主要通过垂直传播或者婴幼儿早期暴露于HBV所致，其中又以产前传播为主，产前传播可分为经胎盘传播和经生殖细胞传播[3-4]。HBV母婴间传播主要途径有：宫内感染（通过胎盘感染胎儿）、生产时感染（生产时接触母血和羊水）、产后感染（密切接触、乳汁传播）[5]。而宫内感染是HBV母婴间传播的主要途径。本研究采用乙型肝炎免疫球蛋白（HBIG）治疗，为临床治疗方案提供借鉴，现报道如下。