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目的探讨采用乙型肝炎免疫球蛋白(HBIG)阻断孕妇乙型肝炎病毒(HBV)感染对新生儿乙型肝炎(简称乙肝)基因疫苗免疫效果的影响。方法对55例HBV标志物阳性孕妇于产前28周、32周和36周分别给予HBIG200IU免疫阻断作为阻断组;31例HBV标志物阳性孕妇未给予HBIG免疫阻断作为未阻断组;同期选择HBV标志物阴性孕妇42例作为对照组。对三组新生儿分别给予乙肝基因疫苗的免疫接种,并分别于1个月、2个月、7个月和12个月龄采集外周血检测HBV标志物及丙氨酸转氨酶(ALT)。结果阻断组、未阻断组和对照组新生儿免疫保护率分别为87.3%(48/55)、77.4%(24/31)和97.6%(41/42);未阻断组与对照组间比较具有统计学意义(P<0.01);对“大三阳”孕妇的阻断效果最好,新生儿抗HBs阳转率从33.3%上升到71.4%。结论对HBV感染孕妇采用HBIG免疫阻断,可以降低宫内感染及母婴传播的发生率;分娩时孕妇HBV感染状态对新生儿抗HBs阳转率可能产生一定程度的影响。
Objective To investigate the effect of using hepatitis B immunoglobulin (HBIG) to block the immune effects of hepatitis B virus (HBV) infection in pregnant women during the period of neonatal hepatitis B virus (HBV) infection. Methods 55 HBsAg positive pregnant women were given HBIG200IU blockade as prenatal 28, 32 and 36 weeks respectively. 31 HBsAg positive pregnant women did not receive HBIG immunosuppression as the non-blocking group. In the same period, 42 HBV negative pregnant women were selected as the control group. Hepatitis B gene vaccines were given to three groups of newborns respectively. Peripheral blood samples were collected for detection of HBV and ALT at 1 month, 2 months, 7 months and 12 months respectively. Results The rates of neonatal immunization were 87.3% (48/55), 77.4% (24/31) and 97.6% (41/42) in the non-occlusion group and the control group, respectively. (P <0.01). The best blocking effect on pregnant women of “big three positive” was achieved. The positive rate of anti-HBs in newborns increased from 33.3% to 71.4%. Conclusion HBIG immunosuppression in pregnant women with HBV infection can reduce the incidence of intrauterine infection and mother-to-child transmission. The status of HBV infection in pregnant women during delivery may have a certain impact on the anti-HBs positive rate in neonates.