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目的研究母体注射乙型肝炎(乙肝)免疫球蛋白对乙肝病毒(HBV)宫内感染的影响及新生儿血清HBV标志物动态变化的分析。方法选取2014年6月-2015年2月该院收治的乙肝表面抗原及乙肝e抗原均阳性孕妇120例,按照孕妇是否愿意接受注射乙肝免疫球蛋白分成观察组62例及对照组58例。观察组单阳性(HBs Ag阳性)孕妇32例,双阳性(HBs Ag及HBe Ag阳性)孕妇30例;对照组中单阳性(HBs Ag阳性)29例,双阳性(HBs Ag及HBe Ag阳性)孕妇29例,4组分别记为Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组。Ⅰ组、Ⅱ组在妊娠第28周起,每周肌注乙肝免疫球蛋白400 U,直至生育新生儿。Ⅲ组、Ⅳ组则给予常规管理。结果 120例孕妇共生育134例新生儿,4组宫内感染率分别为2.63%、18.75%、21.21%、38.71%,相应地检测4组新生儿血清抗HBs产生情况,发现Ⅳ组与其他组比较,差异均具有统计学意义(χ~2=18.939 4,P<0.05)。在新生儿第1年的不断检测下,Ⅰ组发生慢性HBV感染的比例为0.00%,而Ⅱ组、Ⅲ组、Ⅳ组逐渐升高,差异有统计学意义(χ~2=16.813 6,P<0.05)。结论母体注射乙肝免疫球蛋白可有效降低HBV宫内感染概率,新生儿的HBs Ab阳性表达也明显提高,有助于HBV的防治。
Objective To study the effects of maternal hepatitis B (HB) immunoglobulin on intrauterine infection of hepatitis B virus (HBV) and the dynamic changes of serum HBV markers in neonates. Methods 120 cases of HBsAg and HBeAg positive pregnant women admitted from June 2014 to February 2015 in our hospital were divided into observation group (62 cases) and control group (58 cases) according to whether pregnant women were willing to receive hepatitis B immunoglobulin. In the observation group, there were 32 pregnant women with single positive (HBs Ag positive) and 30 pregnant women with double positive (HBs Ag and HBeAg positive). In the control group, 29 were single positive (HBs Ag positive), double positive (HBs Ag and HBe Ag positive) 29 pregnant women, 4 were recorded as Ⅰ group, Ⅱ group, Ⅲ group, Ⅳ group. Group Ⅰ, Ⅱ in the first 28 weeks of pregnancy, intramuscular injection of hepatitis B immunoglobulin 400 U, until the birth of newborns. Group Ⅲ, Ⅳ were given routine management. Results A total of 134 newborns were born in 120 pregnant women. The intrauterine infection rates in 4 groups were 2.63%, 18.75%, 21.21% and 38.71%, respectively. Serum anti-HBs levels in 4 newborns were detected. The differences were statistically significant (χ ~ 2 = 18.939 4, P <0.05). In the first year of newborns, the proportion of patients with chronic HBV infection in group Ⅰ was 0.00%, while in patients in group Ⅱ, Ⅲ and Ⅳ, the difference was statistically significant (χ ~ 2 = 16.813 6, P <0.05). Conclusion The maternal injection of hepatitis B immunoglobulin can effectively reduce the probability of HBV intrauterine infection, and the positive expression of HBs Ab in neonate is also significantly increased, which is helpful for the prevention and treatment of HBV.