目的 探討用乙肝免疫球蛋白經(jīng)母親對(duì)胎兒進(jìn)行被動(dòng)免疫,減弱HBeAg陽(yáng)性孕婦乙型肝炎病毒(HBV)母嬰傳播的力度.
方法 采用前瞻性隨機(jī)對(duì)照研究方法,將新疆4所醫(yī)院1997年至2002年5月產(chǎn)前檢查資料完整、HBeAg陽(yáng)性的52例孕婦隨機(jī)分為兩組,試驗(yàn)組28例,分別在孕28、32及36周各肌注乙肝免疫球蛋白(HBIG)200 IU 1次;對(duì)照組24例,每月只隨訪和體檢,不肌注HBIG.分娩后采集兩組新生兒臍血,分離血清,用ELISA法和熒光定量PCR法檢測(cè)HBeAg和HBV-DNA.
結(jié)果 試驗(yàn)組新生兒HBeAg陽(yáng)性率為21.4%,對(duì)照組新生兒HBeAg陽(yáng)性率為79.2%,其差異有統(tǒng)計(jì)學(xué)意義(x2=17.26,RR=0.27,P＜0.01);試驗(yàn)組新生兒HBV-DNA陽(yáng)性率為25.0%,對(duì)照組新生兒HBV-DNA陽(yáng)性率為83.3%,其差異也有統(tǒng)計(jì)學(xué)意義(x2=17.62,RR=0.30,P＜0.01).試驗(yàn)組新生兒HBV-DNA陰性21例,陽(yáng)性7例,但這7例新生兒HBV-DNA的量均低于其母,其差異有統(tǒng)計(jì)學(xué)意義(經(jīng)Wilcoxon配對(duì)法秩和檢驗(yàn),統(tǒng)計(jì)量T=28,P=0.02).
結(jié)論 對(duì)乙肝HBeAg陽(yáng)性孕婦產(chǎn)前多次肌注HBIG可明顯減弱HBV母嬰傳播力度.
引用本文： 徐秦,肖琳,蔡霞,張躍新,李芳,徐林山,甘為,夏鈺,張新梅,王蘭,楊玲,喬敏,古麗,王曉嵐,周康,陳學(xué)玲,魯曉擘,徐航. 減弱乙肝HBeAg陽(yáng)性孕婦母嬰傳播力度的研究. 中國(guó)循證醫(yī)學(xué)雜志, 2004, 04(5): 306-309. doi: 復(fù)制
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| 1. | 朱啟容,于廣軍,呂晴,俞蕙,顧新煥,張秀珍,董左權(quán).阻斷乙型肝炎病毒宮內(nèi)傳播的隨機(jī)對(duì)照試驗(yàn)[J].中華兒科雜志,2002;40(8):478～480. |
| 2. | ［6］Badur S, Lazizi Y, UgurIu M, Perk Y, IIter O, AydinIi K,Pillot J, Transplacental passage of hepatitis B virus DNA from hepatitis B e antigen negative mothers and delayed immune response in newborns [J]. J Infect Dis, 1994; 169(3): 704 -706. |
| 3. | ［7］Li XM, Yang YB, Hou HY, Shi ZJ, Shen HM, Teng BQ,Li AM, Shi MF, Zou L. Interruption of HBV intrauterine: a clinical study [J]. Ward J Gastroenterol, 2003; 9(7): 1 501- 1 503. |
| 4. | ［8］Towers CV, Asrat T, R umney P. The presence of hepatitis B surface antigen and deoxyribonucleic acid in arnniotic fluid and cord blood [J]. Am J Obstet Gynecol, 2001; 184(7) :1514 - 1 518. |
| 5. | ［9］Lin YL, Kuang JQ, Liu XZ, Chen MY. The expression of HBcAg in HBV carrier mother’ placentas and it’ s significance[J]. Acad J SUMS, 2000; 21(1) :43 -46. |
| 6. | 劉穎琳,鄺健全,劉新質(zhì),陳鏌铘.HbcAg在乙型肝炎病毒攜帶者孕婦胎盤中的識(shí)別與意義.中山醫(yī)科大學(xué)學(xué)報(bào),2000;21(1):43～46. |
| 7. | ［10］Yu GJ, Zhu QR. Study on the relationship between IL-2/IL-2R and immunization failure of hepatitis B vaccine in the children with HBV intrauterine infection [J]. Chinese J Infect Dis, 1998; 16(3): 151-153. |
| 8. | 于光軍,朱啟容.HBV宮內(nèi)感染兒童接種乙型肝炎疫苗免疫失敗與IL-2及其受體的關(guān)系[J].中華傳染病雜志,1998;16(3):151～153. |
| 9. | ［11］Ayoola EA, Johnson AO. Hepatitis B vaccine in pregnancy:immunogenic city, safety and transfer of antibodies to infants[J]. Int J Gynaecol Obstet, 1987; 25(4): 297 -301. |
| 10. | ［12］Hu GY, Tan WH, Wang GR The observation of effects on immunization with hepatitis B vaccine in the late period of pregnancy [J ]. Journal of Harbin Medical University, 1996;30(1) :72 -73. |
| 11. | 胡桂英,譚文華,王桂榮.妊娠后期接種乙肝疫苗免疫效果的觀察[J].哈爾濱醫(yī)科大學(xué)學(xué)報(bào),1996;30(1):72～73. |
| 12. | ［13］Zhang LY, Fang ZX, Zhen ZL, Liu XY, Gong XP, Wu YX. The study of transmission route of HBV fiom father to infant [J]. Chinese J Infect Dis, 1994; 12(4): 199 -201. |
| 13. | 張麗云,方之勛,鄭兆,劉新鈺,龔希平,吳玉祥.父嬰傳播途徑的初步研究[J]中華傳染病雜志,1994;12(4): 199 ～201. |
| 14. | ［14］Zhao LS, Liu XS, Zhang ZX, Wang JR, Liu L, Lei BJ.Study on HBV vertical transmission via infected spermatozoa[J]. Chinese J Infect Dis, 1998; 16(3): 154 - 157. |
| 15. | 趙連三,劉曉松,張智翔,王錦蓉,劉麗,雷秉鈞.乙型肝炎病毒感染經(jīng)精子傳播的可能性研究[J].中華傳染病雜志,1998;16(3):154～157. |
| 16. | ［1］Yue YF, Yang XJ, Zhang SL, Han XB. Clinical study on the prevention of HBV transmission fiom mother to infant by injection of HBIG in pregnant women with HBsAg [J]. Chinese Journal of Practical Gynecology and Obstetrics, 1999; 15(9) :547 -548. |
| 17. | 岳亞飛,楊曉菊,張樹林,韓曉兵.乙肝表面抗原陽(yáng)性孕婦肌注乙肝免疫球蛋白預(yù)防母嬰傳播的臨床研究[J].中國(guó)實(shí)用婦科與產(chǎn)科雜志,1999;15(9):547～548. |
| 18. | ［2］Liu HY, Ma YY, Cui BX, Dal MS, Yang J. The study of mechanism about interrupting HBV transmission from mother to infant by HBIG passive immunization in pregnant women[J]. Current Advances in Obstetrics and Gynecology, 2002; 11(2): 128 -130. |
| 19. | ［3］Ruff TA, Gertig DM, Otto BF, Gust ID, Sutanto A,Soewarso TI, Kandun N, Marschner IC, Maynard JE. Lombok Hepatitis B Model Immunization Project:toward universal infant hepatitis B immunization in Indonesia [J ]. J Infect Dis,1995; 171(2): 290-296. |
| 20. | ［4］Tu SY, Wu Y, Yu DY, Wang Y, Liu QK, Hu GL, Yang WF. The study of interruption of HBV transmission from mother to infant by hepatitis B vaccine [J]. Chinese Journal of Obstetrics and Gynecology, 1991; 26(6): 358-360. |
| 21. | 涂世璽,武玉,余大勇,汪燕,劉慶寬,胡廣連,楊蔚芬.乙型肝炎疫苗阻斷HBV母嬰傳播的研究[J].中華婦產(chǎn)科雜志,1991;26(6):358～360. |
| 22. | ［5］Zhu QR, Yu GJ, Lu Q, Yu H, Gu XH, Zhang XZ, Dong ZQ. A study of Controlled Clinical Trial on interruption of HBV intrauterine transmission [J]. Chinese Journal of Pediatriology, 2002; 40(8): 478-480. |
- 1. 朱啟容,于廣軍,呂晴,俞蕙,顧新煥,張秀珍,董左權(quán).阻斷乙型肝炎病毒宮內(nèi)傳播的隨機(jī)對(duì)照試驗(yàn)[J].中華兒科雜志,2002;40(8):478～480.
- 2. ［6］Badur S, Lazizi Y, UgurIu M, Perk Y, IIter O, AydinIi K,Pillot J, Transplacental passage of hepatitis B virus DNA from hepatitis B e antigen negative mothers and delayed immune response in newborns [J]. J Infect Dis, 1994; 169(3): 704 -706.
- 3. ［7］Li XM, Yang YB, Hou HY, Shi ZJ, Shen HM, Teng BQ,Li AM, Shi MF, Zou L. Interruption of HBV intrauterine: a clinical study [J]. Ward J Gastroenterol, 2003; 9(7): 1 501- 1 503.
- 4. ［8］Towers CV, Asrat T, R umney P. The presence of hepatitis B surface antigen and deoxyribonucleic acid in arnniotic fluid and cord blood [J]. Am J Obstet Gynecol, 2001; 184(7) :1514 - 1 518.
- 5. ［9］Lin YL, Kuang JQ, Liu XZ, Chen MY. The expression of HBcAg in HBV carrier mother’ placentas and it’ s significance[J]. Acad J SUMS, 2000; 21(1) :43 -46.
- 6. 劉穎琳,鄺健全,劉新質(zhì),陳鏌铘.HbcAg在乙型肝炎病毒攜帶者孕婦胎盤中的識(shí)別與意義.中山醫(yī)科大學(xué)學(xué)報(bào),2000;21(1):43～46.
- 7. ［10］Yu GJ, Zhu QR. Study on the relationship between IL-2/IL-2R and immunization failure of hepatitis B vaccine in the children with HBV intrauterine infection [J]. Chinese J Infect Dis, 1998; 16(3): 151-153.
- 8. 于光軍,朱啟容.HBV宮內(nèi)感染兒童接種乙型肝炎疫苗免疫失敗與IL-2及其受體的關(guān)系[J].中華傳染病雜志,1998;16(3):151～153.
- 9. ［11］Ayoola EA, Johnson AO. Hepatitis B vaccine in pregnancy:immunogenic city, safety and transfer of antibodies to infants[J]. Int J Gynaecol Obstet, 1987; 25(4): 297 -301.
- 10. ［12］Hu GY, Tan WH, Wang GR The observation of effects on immunization with hepatitis B vaccine in the late period of pregnancy [J ]. Journal of Harbin Medical University, 1996;30(1) :72 -73.
- 11. 胡桂英,譚文華,王桂榮.妊娠后期接種乙肝疫苗免疫效果的觀察[J].哈爾濱醫(yī)科大學(xué)學(xué)報(bào),1996;30(1):72～73.
- 12. ［13］Zhang LY, Fang ZX, Zhen ZL, Liu XY, Gong XP, Wu YX. The study of transmission route of HBV fiom father to infant [J]. Chinese J Infect Dis, 1994; 12(4): 199 -201.
- 13. 張麗云,方之勛,鄭兆,劉新鈺,龔希平,吳玉祥.父嬰傳播途徑的初步研究[J]中華傳染病雜志,1994;12(4): 199 ～201.
- 14. ［14］Zhao LS, Liu XS, Zhang ZX, Wang JR, Liu L, Lei BJ.Study on HBV vertical transmission via infected spermatozoa[J]. Chinese J Infect Dis, 1998; 16(3): 154 - 157.
- 15. 趙連三,劉曉松,張智翔,王錦蓉,劉麗,雷秉鈞.乙型肝炎病毒感染經(jīng)精子傳播的可能性研究[J].中華傳染病雜志,1998;16(3):154～157.
- 16. ［1］Yue YF, Yang XJ, Zhang SL, Han XB. Clinical study on the prevention of HBV transmission fiom mother to infant by injection of HBIG in pregnant women with HBsAg [J]. Chinese Journal of Practical Gynecology and Obstetrics, 1999; 15(9) :547 -548.
- 17. 岳亞飛,楊曉菊,張樹林,韓曉兵.乙肝表面抗原陽(yáng)性孕婦肌注乙肝免疫球蛋白預(yù)防母嬰傳播的臨床研究[J].中國(guó)實(shí)用婦科與產(chǎn)科雜志,1999;15(9):547～548.
- 18. ［2］Liu HY, Ma YY, Cui BX, Dal MS, Yang J. The study of mechanism about interrupting HBV transmission from mother to infant by HBIG passive immunization in pregnant women[J]. Current Advances in Obstetrics and Gynecology, 2002; 11(2): 128 -130.
- 19. ［3］Ruff TA, Gertig DM, Otto BF, Gust ID, Sutanto A,Soewarso TI, Kandun N, Marschner IC, Maynard JE. Lombok Hepatitis B Model Immunization Project:toward universal infant hepatitis B immunization in Indonesia [J ]. J Infect Dis,1995; 171(2): 290-296.
- 20. ［4］Tu SY, Wu Y, Yu DY, Wang Y, Liu QK, Hu GL, Yang WF. The study of interruption of HBV transmission from mother to infant by hepatitis B vaccine [J]. Chinese Journal of Obstetrics and Gynecology, 1991; 26(6): 358-360.
- 21. 涂世璽,武玉,余大勇,汪燕,劉慶寬,胡廣連,楊蔚芬.乙型肝炎疫苗阻斷HBV母嬰傳播的研究[J].中華婦產(chǎn)科雜志,1991;26(6):358～360.
- 22. ［5］Zhu QR, Yu GJ, Lu Q, Yu H, Gu XH, Zhang XZ, Dong ZQ. A study of Controlled Clinical Trial on interruption of HBV intrauterine transmission [J]. Chinese Journal of Pediatriology, 2002; 40(8): 478-480.