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目的探讨HBsAg阳性孕妇的婴儿阻断有效后继续随访和治疗的必要性和临床意义。方法2001-01—2004-01对南京第二医院HBsAg阳性孕妇及婴儿实施联合免疫,婴儿于12月龄抽血检测乙肝病毒标志物(HBVm)、HBV-DNA和肝功能。将获阻断有效的4种HBVm模式(抗HBs<100mIU/mL,抗HBs、抗HBc两项阳性,抗HBs、抗HBe、抗HBc三项阳性,HBsAg或HBeAg低滴度)的婴儿分为A、B1、C1、D1四组,后三组设B2、C2、D2对照组,对A、B1、C1组婴儿再予乙肝疫苗(HBVac)20μg接种3次,D1组予同剂量HBVac治疗12次,对照组不作任何治疗。24月龄时随访HBVm、HBV-DNA和肝功能。结果治疗有效率A组为100%(24/24),B1组57.1%(20/35),C1组66.7%(10/15),D1组70.0%(7/10)。B1、C1、D1组婴儿治疗后抗HBs平均滴度分别为(745.34±238.81)、(691.65±153.76)、(602.56±212.83)mIU/mL,明显高于对照组,P<0.05。B1、C1、D1组婴儿治疗前后HBV-DNA阳性率和丙氨酸氨基转移酶(ALT)差异无显著性,P>0.05。结论获阻断有效的婴儿有必要继续随访,多次予HBVac免疫治疗可以提高抗HBs滴度,清除乙肝病毒的低水平感染。
Objective To investigate the necessity and clinical significance of continuous follow-up and treatment of infants with positive HBsAg-positive mothers after effective blockade. Methods The co-immunization of HBsAg positive pregnant women and their infants at the Second Hospital of Nanjing from January 2001 to April 2004 was performed. The infants were tested for HBV-DNA, HBV-DNA and liver function at 12 months of age. Four infants with blockade of HBVm mode (anti-HBs <100 mIU / mL, anti-HBs, anti-HBc positive, anti-HBs, anti-HBe, anti-HBc positive, HBsAg or HBeAg low titers) A, B1, C1 and D1. The last three groups were divided into B2, C2 and D2 control groups. The infants in groups A, B1 and C1 were inoculated three times with 20μg of hepatitis B vaccine (HBVac) Times, the control group without any treatment. 24-month-old follow-up HBVm, HBV-DNA and liver function. Results The effective rate of treatment was 100% (24/24) in group A, 57.1% (20/35) in group B1, 66.7% (10/15) in group C1 and 70.0% (7/10) in group D1. The average titers of anti-HBs in infants after treatment were (745.34 ± 238.81), (691.65 ± 153.76) and (602.56 ± 212.83) mIU / mL respectively in B1, C1 and D1 groups, which were significantly higher than those in control group (P <0.05). The positive rate of HBV-DNA and the level of alanine aminotransferase (ALT) before and after treatment in infants in B1, C1 and D1 groups were not significantly different (P> 0.05). Conclusion It is necessary to continue follow-up of obstructive effective infants. Repeated immunization with HBVac can increase the anti-HBs titer and clear the low-level infection of hepatitis B virus.