论文部分内容阅读
目的 探讨用乙肝免疫球蛋白经母亲对胎儿进行被动免疫 ,减弱HBeAg阳性孕妇乙型肝炎病毒 (HBV)母婴传播的力度。 方法 采用前瞻性随机对照研究方法 ,将新疆 4所医院 1997年至 2 0 0 2年 5月产前检查资料完整、HBeAg阳性的 5 2例孕妇随机分为两组 ,试验组 2 8例 ,分别在孕 2 8、32及 36周各肌注乙肝免疫球蛋白 (HBIG) 2 0 0IU 1次 ;对照组 2 4例 ,每月只随访和体检 ,不肌注HBIG。分娩后采集两组新生儿脐血 ,分离血清 ,用ELISA法和荧光定量PCR法检测HBeAg和HBV DNA。 结果 试验组新生儿HBeAg阳性率为 2 1 4 % ,对照组新生儿HBeAg阳性率为 79 2 % ,其差异有统计学意义 (χ2 =17 2 6 ,RR =0 2 7,P <0 0 1) ;试验组新生儿HBV DNA阳性率为 2 5 0 % ,对照组新生儿HBV DNA阳性率为 83 3% ,其差异也有统计学意义 (χ2 =17 6 2 ,RR =0 30 ,P <0 0 1)。试验组新生儿HBV DNA阴性 2 1例 ,阳性 7例 ,但这 7例新生儿HBV DNA的量均低于其母 ,其差异有统计学意义 (经Wilcoxon配对法秩和检验 ,统计量T =2 8,P =0 0 2 )。 结论 对乙肝HBeAg阳性孕妇产前多次肌注HBIG可明显减弱HBV母婴传播力度。
Objective To investigate the passive immunization of fetuses with hepatitis B immunoglobulin by mother to reduce the intensity of hepatitis B virus (HBV) maternal-to-infant transmission in HBeAg-positive pregnant women. Methods A prospective randomized controlled study was conducted. The data of prenatal examination from 4 hospitals in Xinjiang from May 1997 to May 2002 were complete. Fifty-two pregnant women with HBeAg positive were randomly divided into two groups, with 28 cases in trial group The pregnant women received intramuscular injection of hepatitis B immunoglobulin (HBIG) 200 IU intramuscularly at 28, 32 and 36 weeks of gestation. In the control group, 24 patients received monthly intramuscular injection of HBIG only after follow-up and physical examination. After delivery, two groups of neonatal cord blood were collected and serum was separated. HBeAg and HBV DNA were detected by ELISA and fluorescence quantitative PCR. Results The positive rate of HBeAg in neonates was 21.4% in the experimental group and 79.2% in the neonates of the control group (χ2 = 17 2 6, RR = 0 27, P 0 01 ). The positive rate of HBV DNA in the experimental group was 25.0%, while the positive rate of HBV DNA in the control group was 83.3% (χ2 = 1762, RR = 030, P <0 0 1). The experimental group neonatal HBV DNA negative 21 cases, 7 cases of positive, but these 7 cases of neonatal HBV DNA were lower than the mother, the difference was statistically significant (by Wilcoxon matching rank sum test, the statistic T = 2 8, P = 0 0 2). Conclusions Multiple intramuscular HBIG prenatal hepatitis B HBeAg-positive pregnant women can significantly attenuate HBV transmission.