CAJ | 학술논문

目的：：探讨母体注射乙肝免疫球蛋白( HBIG)阻断HBV母婴垂直传播的被动免疫效果和机制。方法：选取本院收治的慢性乙型病毒性肝炎孕产妇94例，随机分为对照组31例，婴儿干预组31例，和母婴共干预组32例；对照组不给予HBIG干预，婴儿干预组在婴儿出生6 h之内给予HBIG干预，母婴共干预组分别在母体孕28、32、36周和婴儿出生6 h之内给予HBIG干预；此外，三组新生儿均在出生后0、1、6月接种乙肝疫苗，并于末次接种后取患儿空腹外周血，进行乙肝标记物、HBV-DNA及免疫功能检测。结果：三组新生儿HBeAg、HBsAg、HBV-DNA阳性率有显著性差异( P<0．05)，以对照组为最高，母婴共干预组最低；HBeAb阳性率亦有显著性差异(P<0．05)，以对照组为最低，母婴共干预组最高。三组新生儿的补体C3、C4水平及T淋巴细胞亚型CD3+ T、CD4+ T、CD8+ T计数均有显著性差异( P<0．05)，以对照组为最低，母婴共干预组最高；在免疫球蛋白方面，婴儿干预组和母婴共干预组的IgG、IgM显著高于对照组( P<0．05)，而IgA无明显组间差异( P<0．05)。结论：母体HBIG注射可有效激活母体的体液免疫和细胞免疫，降低母体中病毒含量。此外，通过胎盘对胎儿的影响，协同使新生儿产生抗原-抗体反应，缓解HBV病毒所诱发的T淋巴细胞耗损，有可能发挥其对HBV母婴垂直传播的阻断作用。
목적：：탐토모체주사을간면역구단백( HBIG)조단HBV모영수직전파적피동면역효과화궤제。방법：선취본원수치적만성을형병독성간염잉산부94례，수궤분위대조조31례，영인간예조31례，화모영공간예조32례；대조조불급여HBIG간예，영인간예조재영인출생6 h지내급여HBIG간예，모영공간예조분별재모체잉28、32、36주화영인출생6 h지내급여HBIG간예；차외，삼조신생인균재출생후0、1、6월접충을간역묘，병우말차접충후취환인공복외주혈，진행을간표기물、HBV-DNA급면역공능검측。결과：삼조신생인HBeAg、HBsAg、HBV-DNA양성솔유현저성차이( P<0．05)，이대조조위최고，모영공간예조최저；HBeAb양성솔역유현저성차이(P<0．05)，이대조조위최저，모영공간예조최고。삼조신생인적보체C3、C4수평급T림파세포아형CD3+ T、CD4+ T、CD8+ T계수균유현저성차이( P<0．05)，이대조조위최저，모영공간예조최고；재면역구단백방면，영인간예조화모영공간예조적IgG、IgM현저고우대조조( P<0．05)，이IgA무명현조간차이( P<0．05)。결론：모체HBIG주사가유효격활모체적체액면역화세포면역，강저모체중병독함량。차외，통과태반대태인적영향，협동사신생인산생항원-항체반응，완해HBV병독소유발적T림파세포모손，유가능발휘기대HBV모영수직전파적조단작용。
Objective:To discuss the passive immunity effect and mechanism of HBIG injections to matrix to block the mother-to-child vertical transmission of HBV. Methods:94 cases of patients with chronic viral hepatitis were selected and divided into 3 groups randomly. 31 cases of control group were given no HBIG intervention,while 31 cases of baby intervention ( BBI) group were given HBIG injection in 6h of birth,and 32 cases of infant & mom intervention ( IMI) group were given HBIG injection respectively in 28,32,36 weeks of gestation and 6h of birth. Further more,all newborns were vaccinated against hepatitis B in 0,1 and 6 months,after the last vaccination,peripheral blood of the children were extracted and detected for HBV markers,HBV-DNA and immune function. Results:There were significant difference (P<0. 05) in neonatal HBeAg,HBsAg and HBV-DNA positive rate for the three groups,with Control group got the highest while IMI group got the lowest;and there are also significant differences (P<0. 05) HBeAb positive rate,with Control group got the lowest while IMI group got the highest. We also found that the complement (C3,C4) levels and T cell subtypes (CD3+,CD4+,CD8+) count of the three groups of newborns had significant differences too(P<0. 05),with Control group got the lowest while IMI group got the highest;in terms of immunoglobulin,both the IMI and BBI group were higher in IgG and IgM level (P<0. 05), while there was no obvious difference in IgA between groups (P<0. 05). Conclusion:Maternal HBIG injections can effectively activate the maternal humoral immunity and cellular immunity,resulting in the decrease of HBV. It can also improve newborn′s antigen-antibody response and relieve T lymphocytes loss induced by antiviral consumption through placenta,which may play great role in the passive im-munity mechanism of blocking mother-to-fetus transmission.