中华肝脏病杂志
中華肝髒病雜誌
중화간장병잡지
CHINESE JOURNAL OF HEPATOLOGY
2011年
11期
818-822
,共5页
江红秀%韩国荣%王翠敏%岳欣%王根菊
江紅秀%韓國榮%王翠敏%嶽訢%王根菊
강홍수%한국영%왕취민%악흔%왕근국
肝炎病毒,乙型%肝炎疫苗,乙型%疾病传播,垂直
肝炎病毒,乙型%肝炎疫苗,乙型%疾病傳播,垂直
간염병독,을형%간염역묘,을형%질병전파,수직
Hepatitis B virus%Hepatitis B vaccines%Disease transmission,vertical
目的 观察HBeAg阳性且HBV DNA高载量孕妇所生婴儿用乙型肝炎疫苗联合免疫接种后的母婴阻断效果及HBV血清学标志物的动态变化.方法 回顾性分析HBeAg阳性且HBVDNA≥106拷贝/ml孕妇127例,婴儿出生后即刻及第15天于臀大肌注射高效价乙型肝炎免疫球蛋白200 IU,出生时与第1、6个月于右上臂肌肉注射乙型肝炎疫苗20μg,随访其婴儿至12个月龄.用酶联免疫吸附法及荧光定量PcR检测婴儿出生时及第1、7、12个月时的HBV血清学标志物和HBV DNA载量,观察婴儿出生时HBV血清学标志物模式、母婴传播率、疫苗接种后的HBV宫内感染率、抗-HBs阳性保护率及HBV血清学标志物动态变化.结果 127例孕妇分娩婴儿均为单胎,出生时29例婴儿HBsAg为阳性,其中11例合并HBV DNA阳性,母婴垂直传播率为22.83％.随访至1个月,10例婴儿合并HBV DNA阳性从而发生HBV宫内感染,表现为HBsAg、HBeAg及抗-HBc均为阳性.2例婴儿HBsAg弱阳性,伴有抗-HBs滴度的产生,后续随访中均转阴,乙型肝炎宫内感染率为7.87％.非宫内感染婴儿出生时HBeAg及抗-HBc阳性率分别为96.58％和98.29％,免疫接种后婴儿HBeAg及抗-HBc逐步转阴,均未产生抗-Hbe.非宫内感染婴儿均产生有效乙型肝炎保护性抗体,乙型肝炎疫苗及高效价乙型肝炎免疫球蛋白联合免疫接种后,婴儿抗-HBs滴度从出生至12个月龄逐步上升,母源性HBeAg滴度逐步下降以至转阴.结论 乙型肝炎疫苗联合高效价乙型肝炎免疫球蛋白免疫接种能明显降低HBV母婴传播,增强婴儿乙型肝炎表面抗原保护性抗体,体内母源性HBeAg及抗-HBc亦随之降低甚至转阴.
目的 觀察HBeAg暘性且HBV DNA高載量孕婦所生嬰兒用乙型肝炎疫苗聯閤免疫接種後的母嬰阻斷效果及HBV血清學標誌物的動態變化.方法 迴顧性分析HBeAg暘性且HBVDNA≥106拷貝/ml孕婦127例,嬰兒齣生後即刻及第15天于臀大肌註射高效價乙型肝炎免疫毬蛋白200 IU,齣生時與第1、6箇月于右上臂肌肉註射乙型肝炎疫苗20μg,隨訪其嬰兒至12箇月齡.用酶聯免疫吸附法及熒光定量PcR檢測嬰兒齣生時及第1、7、12箇月時的HBV血清學標誌物和HBV DNA載量,觀察嬰兒齣生時HBV血清學標誌物模式、母嬰傳播率、疫苗接種後的HBV宮內感染率、抗-HBs暘性保護率及HBV血清學標誌物動態變化.結果 127例孕婦分娩嬰兒均為單胎,齣生時29例嬰兒HBsAg為暘性,其中11例閤併HBV DNA暘性,母嬰垂直傳播率為22.83％.隨訪至1箇月,10例嬰兒閤併HBV DNA暘性從而髮生HBV宮內感染,錶現為HBsAg、HBeAg及抗-HBc均為暘性.2例嬰兒HBsAg弱暘性,伴有抗-HBs滴度的產生,後續隨訪中均轉陰,乙型肝炎宮內感染率為7.87％.非宮內感染嬰兒齣生時HBeAg及抗-HBc暘性率分彆為96.58％和98.29％,免疫接種後嬰兒HBeAg及抗-HBc逐步轉陰,均未產生抗-Hbe.非宮內感染嬰兒均產生有效乙型肝炎保護性抗體,乙型肝炎疫苗及高效價乙型肝炎免疫毬蛋白聯閤免疫接種後,嬰兒抗-HBs滴度從齣生至12箇月齡逐步上升,母源性HBeAg滴度逐步下降以至轉陰.結論 乙型肝炎疫苗聯閤高效價乙型肝炎免疫毬蛋白免疫接種能明顯降低HBV母嬰傳播,增彊嬰兒乙型肝炎錶麵抗原保護性抗體,體內母源性HBeAg及抗-HBc亦隨之降低甚至轉陰.
목적 관찰HBeAg양성차HBV DNA고재량잉부소생영인용을형간염역묘연합면역접충후적모영조단효과급HBV혈청학표지물적동태변화.방법 회고성분석HBeAg양성차HBVDNA≥106고패/ml잉부127례,영인출생후즉각급제15천우둔대기주사고효개을형간염면역구단백200 IU,출생시여제1、6개월우우상비기육주사을형간염역묘20μg,수방기영인지12개월령.용매련면역흡부법급형광정량PcR검측영인출생시급제1、7、12개월시적HBV혈청학표지물화HBV DNA재량,관찰영인출생시HBV혈청학표지물모식、모영전파솔、역묘접충후적HBV궁내감염솔、항-HBs양성보호솔급HBV혈청학표지물동태변화.결과 127례잉부분면영인균위단태,출생시29례영인HBsAg위양성,기중11례합병HBV DNA양성,모영수직전파솔위22.83％.수방지1개월,10례영인합병HBV DNA양성종이발생HBV궁내감염,표현위HBsAg、HBeAg급항-HBc균위양성.2례영인HBsAg약양성,반유항-HBs적도적산생,후속수방중균전음,을형간염궁내감염솔위7.87％.비궁내감염영인출생시HBeAg급항-HBc양성솔분별위96.58％화98.29％,면역접충후영인HBeAg급항-HBc축보전음,균미산생항-Hbe.비궁내감염영인균산생유효을형간염보호성항체,을형간염역묘급고효개을형간염면역구단백연합면역접충후,영인항-HBs적도종출생지12개월령축보상승,모원성HBeAg적도축보하강이지전음.결론 을형간염역묘연합고효개을형간염면역구단백면역접충능명현강저HBV모영전파,증강영인을형간염표면항원보호성항체,체내모원성HBeAg급항-HBc역수지강저심지전음.
Objective To evaluate the efficacy of combined vaccination with 200IU dose of HBIG and 20 μg of anti-HBV vaccine for the prevention of HBV vertical transmission in babies dilivered by HBeAg + and highly viremic mothers and the HBV markers' dynamic changes in babies during followup.Methods HBeAg + mothers with HBV DNA≥1.0×6log10 copies/ml were enrolled and their babies were followed up until 12 months old.The infants received HBIG 200 IU IM in 24 hrs and on day 15,and 20 μg recombinant anti-HBV vaccine at 0,land 6months.The HBV markers and HBV DNA were tested at birth day,and 1,7,12 months after birth respectively.The vertical transmission rate at birth and intrauterine infection rate,the HBsAb positive rate and the HBV markers' dynamic changes during follow up were evaluated.Results (1) 29 out of 127 infants with HBsAg (+) at birth,11 of which were HBV DNA (+),HBV perinatal transmission rate was 22.83％.2 infants' HBsAg were positive at monthl and became negative at month 7 and 10 infants were still HBsAg (+) and HBV DNA (+).HBV intrauterine infection rate was 7.87％.(2) The positive rate of HBeAg and HBcAb in uninfected infants were 96.58％ and 98.29％ respectively,which declined gradually to undetectable level after immunization.No infants were HBeAb (+).(3) Infants uninfected produced effective HBsAb after vaccination.The level of HBsAb elevated gradually,and the level of HBeAg decreased quickly even to undetectable.Conclusion The combination vaccination of 200 IU HBIG with 20 μg recombinant anti-HBV vaccine in the Infants delivered by HBeAg + and highly viremic mothers reduced obviously the rate of perinatal transmission of HBV,enhanced largely the production of antibody against HBV surface antigen and dropped the maternal HBeAg and HBcAb in infants or even to negative.
