減弱乙肝HBeAg陽性孕婦母嬰傳播力度的研究_《中國循證醫學雜志》

作者：

徐秦 ¹ , 肖琳 ² , 蔡霞 ² , 張躍新 ² , 李芳 ² , 徐林山 ³ , 甘為 ⁴ , 夏鈺 ⁵ , 張新梅 ² , 王蘭 ⁶ , 楊玲 ⁷ , 喬敏 ⁸ , 古麗 ² , 王曉嵐 ² , 周康 ¹ , 陳學玲 ¹ , 魯曉擘 ² , 徐航 ²

1. 新疆醫科大學公共衛生學院,烏魯木齊,8300542. 新疆醫科大學第一附屬醫院,烏魯木齊,8300543. 上海復旦大學公共衛生學院,上海,2004334. 山東省電力局醫院,濟南,2500015. 烏魯木齊鐵路防疫站,烏魯木齊,8300546. 新疆建工醫院,烏魯木齊,8300547. 烏魯木齊市婦幼保健院,烏魯木齊,8300548. 新疆軍區總醫院,烏魯木齊,830054;

關鍵詞：

乙型肝炎 HBeAg 母嬰傳播乙肝免疫球蛋白隨機對照試驗

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目的　探討用乙肝免疫球蛋白經母親對胎兒進行被動免疫,減弱HBeAg陽性孕婦乙型肝炎病毒(HBV)母嬰傳播的力度.
方法　采用前瞻性隨機對照研究方法,將新疆4所醫院1997年至2002年5月產前檢查資料完整、HBeAg陽性的52例孕婦隨機分為兩組,試驗組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HBeAg和HBV-DNA.
結果　試驗組新生兒HBeAg陽性率為21.4%,對照組新生兒HBeAg陽性率為79.2%,其差異有統計學意義(x2=17.26,RR=0.27,P＜0.01);試驗組新生兒HBV-DNA陽性率為25.0%,對照組新生兒HBV-DNA陽性率為83.3%,其差異也有統計學意義(x2=17.62,RR=0.30,P＜0.01).試驗組新生兒HBV-DNA陰性21例,陽性7例,但這7例新生兒HBV-DNA的量均低于其母,其差異有統計學意義(經Wilcoxon配對法秩和檢驗,統計量T=28,P=0.02).
結論　對乙肝HBeAg陽性孕婦產前多次肌注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,陳學玲,魯曉擘,徐航. 減弱乙肝HBeAg陽性孕婦母嬰傳播力度的研究. 中國循證醫學雜志, 2004, 04(5): 306-309. doi: 復制

1.	朱啟容,于廣軍,呂晴,俞蕙,顧新煥,張秀珍,董左權.阻斷乙型肝炎病毒宮內傳播的隨機對照試驗[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,陳鏌铘.HbcAg在乙型肝炎病毒攜帶者孕婦胎盤中的識別與意義.中山醫科大學學報,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].哈爾濱醫科大學學報,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.乙肝表面抗原陽性孕婦肌注乙肝免疫球蛋白預防母嬰傳播的臨床研究[J].中國實用婦科與產科雜志,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.阻斷乙型肝炎病毒宮內傳播的隨機對照試驗[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,陳鏌铘.HbcAg在乙型肝炎病毒攜帶者孕婦胎盤中的識別與意義.中山醫科大學學報,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].哈爾濱醫科大學學報,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.乙肝表面抗原陽性孕婦肌注乙肝免疫球蛋白預防母嬰傳播的臨床研究[J].中國實用婦科與產科雜志,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.

《中國循證醫學雜志》

減弱乙肝HBeAg陽性孕婦母嬰傳播力度的研究

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《中國循證醫學雜志》

減弱乙肝HBeAg陽性孕婦母嬰傳播力度的研究

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