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目的比较对乙肝不同感染状态孕妇实施不同的主被动联合免疫方法后阻断母婴垂直传播的临床疗效。方法将86例HBsAg阳性孕妇随机分为两组,每组43例,实验组孕妇从孕28周起每4周肌注乙肝免疫球蛋白(HBIG)200 IU,共3次,对照组不用HBIG,两组新生儿均于出生后立即和15 d各肌注HBIG200 IU,0、1、6个月分别接种基因疫苗10 ug。新生儿于出生时采脐血和12月龄时抽取股静脉血,检测血清HBsAg、抗-HBs。结果两组乙肝单阳孕妇采用不同的主被动联合免疫所娩新生儿及12月龄的抗-HBs产生率及乙肝感染率差异无统计学意义(P>0.05)。实验组双阳孕妇所娩新生儿出生时和12月龄抗-HBs产生率分别为33.3%、83.3%,对照组分别为11.1%、44.4%,两组比较差异有统计学意义(P<0.01)。对照组双阳孕妇所娩新生儿出生时乙肝感染率(22.2%)明显高于实验组(8.3%),差异有统计学意义(P<0.01)。结论对乙肝双阳孕妇采用宫内主被动联合免疫阻断乙肝病毒垂直传播的效果优于出生后主被动联合免疫。
Objective To compare the clinical efficacy of different active and passive combined immunization in pregnant women with different infection status of hepatitis B to block the vertical transmission of mother and infant. Methods Eighty-six HBsAg positive pregnant women were randomly divided into two groups (43 cases in each group). Pregnant women in experimental group received intramuscular injection of 200 IU HBIG every 4 weeks from the 28th week of pregnancy. The control group received no HBIG, Both newborns were vaccinated with HBIG 200 IU immediately after birth and 15 μg intramuscularly with 10 μg of gene vaccine at 0, 1, 6 months respectively. Neonates were taken cord blood at birth and 12-month-old femoral vein blood samples were taken for detection of serum HBsAg and anti-HBs. Results There was no significant difference in the incidence of anti-HBs and hepatitis B infection between the two groups of newborns and the 12-month-old pregnant women who were treated by combined active and passive immunization. The positive rate of anti-HBs produced at the birth and 12-month-old neonates in the experimental group was 33.3% and 83.3% respectively, while that in the control group was 11.1% and 44.4% respectively, with significant difference between the two groups (P <0.01) . The birth rate of newborn infants born in Shuangyang pregnant women in the control group (22.2%) was significantly higher than that in the experimental group (8.3%), the difference was statistically significant (P <0.01). Conclusion The positive and negative passive immunization combined with intrauterine immunization in hepatitis B and M (HBeAg) positive pregnant women is more effective in blocking the vertical transmission of hepatitis B virus than in primary and passive combined immunization.