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目的观察乙型肝炎人免疫球蛋白(HBIG)与乙型肝炎(乙肝)疫苗联合应用对乙型肝炎表面抗原(HBs Ag)携带孕妇所产新生儿阻断乙型肝炎病毒(HBV)母婴传播,提高HBs Ag携带孕妇所产新生儿免疫效果。方法 2011年仅常规接种乙肝疫苗治疗的80例HBs Ag阳性孕妇所产新生儿为对照组,2014年采用HBIG和乙肝疫苗联合免疫治疗的80例HBs Ag阳性孕妇所产新生儿为研究组。研究组根据母亲乙肝标志物状况分为HBs Ag(+)、HBe Ag(+)组(33例)和HBs Ag(+)、HBe Ag(-)组(47例)。研究组出生后4 h内、2周肌内注射HBIG,0、1、6个月注射重组乙肝疫苗(酵母)。对照组于出生后0、1、6个月注射重组乙肝疫苗(酵母),未联合HBIG。新生儿于7个月龄时采血进行HBs Ag、HBe Ag测定。结果研究组新生儿血清HBs Ag阳性率2.50%,明显低于对照组的18.75%(P<0.05);研究组中HBs Ag(+)、HBe Ag(+)组的新生儿感染率显著高于HBs Ag(+)、HBe Ag(-)组(P<0.05)。结论 HBs Ag携带孕妇所产新生儿出生后给予HBIG、乙肝疫苗联合免疫可明显降低HBV母婴传播,母亲HBe Ag(+)是造成母婴阻断失败的主要原因。
Objective To observe the effect of combined use of hepatitis B immunoglobulin (HBIG) and hepatitis B (hepatitis B) vaccine on neonatal transmission of hepatitis B virus (HBV) in pregnant women born with hepatitis B surface antigen (HBsAg) , To improve the neonatal immune response to HBs Ag in pregnant women. Methods Eighty newborns born of HBsAg-positive pregnant women who received routine hepatitis B vaccine in 2011 were selected as the control group. In 2014, 80 newborn babies born to HBsAg-positive pregnant women treated with HBIG and hepatitis B vaccine were enrolled in this study. The study group was divided into HBsAg (+), HBeAg (+) group (33cases) and HBs Ag (+), HBe Ag (-) group (47cases) according to the mother’s hepatitis B status. The study group was injected with HBIG intramuscularly within 2 hours after birth and recombinant hepatitis B vaccine (yeast) within 0, 1, 6 months after birth. The control group was injected with recombinant hepatitis B vaccine (yeast) at 0, 1 and 6 months after birth without combined with HBIG. Blood samples were taken from newborns at 7 months of age for HBsAg and HBeAg measurements. Results The positive rate of HBs Ag in study group was 2.50%, which was significantly lower than that in control group (18.75%, P <0.05). The infection rate of HBs Ag (+) and HBe Ag (+) group in study group was significantly higher than that of HBsAg HBsAg (+), HBeAg (-) group (P <0.05). CONCLUSIONS: HBsAg-bearing pregnant women are given HBIG after birth, and combined immunization with hepatitis B vaccine can significantly reduce the mother-to-child transmission of HBV. Mother HBe Ag (+) is the main cause of the failure of mother-infant blockade.