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目的探讨乙型肝炎病毒(HBV)父婴垂直传播(P-FT)的关系及预防措施。方法选取2007年01月～2008年12月因体检筛查丈夫血清HBV-DNA阳性而妻子无HBV感染的病例。妻子以乙肝疫苗(HBVac)免疫至抗-HBs抗体阳性后再妊娠的78例夫妇作为观察组,自孕28周起每4周肌注乙肝免疫球蛋白(HBIG)200U至产前。另筛选入院时孕妇无HBV感染,而丈夫血清HBV-DNA阳性的36例夫妇作为对照组。两组新生儿均于出生后24h内采血检测血清HBV-DNA及抗-HBs抗体,观察两组新生儿HBV感染率及抗-HBs抗体阳性率。结果观察组新生儿HBV感染率为15.38%(12/78),明显低于对照组的44.44%(16/36),差异有显著性意义(x~2=11.23,P<0.05);观察组抗-HBs抗体阳性率为47.44%(37/78),明显高于对照组的0(0/36),差异有非常显著性意义(x~2=25.28,P<0.05)。结论 HBV存在父婴垂直传播而引起宫内感染,孕前肌注乙肝疫苗、孕晚期肌注乙肝免疫球蛋白的预防免疫手段可有效预防HBV的父婴垂直传播。
Objective To explore the relationship between hepatitis B virus (HBV) vertical transmission of mother and infant (P-FT) and preventive measures. Methods Selected from January 2007 to December 2008 due to physical screening of her husband serum HBV-DNA positive and his wife no HBV infection. The wife of hepatitis B vaccine (HBVac) to anti-HBs antibody positive pregnancy 78 couples as the observation group, from the 28th week of pregnancy every 4 weeks intramuscular injection of hepatitis B immunoglobulin (HBIG) 200U to the prenatal. Another screening of pregnant women without HBV infection, while her husband serum HBV-DNA positive 36 couples as a control group. Serum HBV-DNA and anti-HBs antibodies were detected by blood sampling within 24 hours after birth in both groups of neonates. HBV infection rate and the positive rate of anti-HBs antibodies in two groups were observed. Results The HBV infection rate in observation group was 15.38% (12/78), which was significantly lower than that in control group (44.44%, 16/36) (x ~ 2 = 11.23, P <0.05) The positive rate of anti-HBs antibody was 47.44% (37/78), which was significantly higher than that of the control group (0/36). The difference was significant (x ~ 2 = 25.28, P <0.05). Conclusion There is an intrauterine infection caused by the vertical transmission of HBV in pregnant women and fetuses with intrahepatic HBV infection. Preventive immunization with intramuscular injection of hepatitis B immunoglobulin during the third trimester of pregnancy can effectively prevent the vertical transmission of HBV.