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目的:探讨孕妇血清HBV DNA含量对乙肝疫苗与HBIG联合免疫阻断HBV母婴传播效果的影响。方法:53例HBsAg阳性且持续时间超过6个月的孕妇及其所生的53例婴儿,按照孕妇血清HBV DNA水平分3组,即>106拷贝/ml、103～106拷贝/ml和<103拷贝/ml 3组,所有婴儿于出生6 h内及30天分别注射200 IU HBIG,同时分别于出生24 h内、生后1个月及生后6个月注射3次20μg的重组酵母乙肝疫苗。检测孕妇分娩时和婴儿出生时以及1岁时静脉血HBV标志物和HBVDNA含量。结果:3组孕妇HBsAg滴度之间无显著差别(P>0.05);HBV DNA>106拷贝/ml组血清HBeAg阳性率和滴度均显著高于103～106拷贝/ml和<103拷贝/ml组(P<0.05)。所有新生儿血清HBV DNA水平均小于检测下限(1 000拷贝/mL);HBsAg阳性率为9.4%(5/53),3组新生儿HBsAg阳性率和滴度无显著差别(P>0.05);随着孕妇HBV DNA水平升高,新生儿血清HBeAg阳性率和滴度相应增高,而抗-HBe阳性率和滴度相应降低,各组间差异具有统计学意义(P<0.05)。婴儿出生12个月时,所有婴儿血清HBsAg和HBeAg检测结果均为阴性,血清HBV DNA水平均在检测下限以下。HBV DNA>106拷贝/ml组血清抗-HBs水平显著低于103～106拷贝/ml和<103拷贝/ml组,P值分别为0.021和0.011。结论:孕妇高病毒载量对乙肝母婴传播阻断成功率有一定影响。
Objective: To investigate the effects of serum HBV DNA level in pregnant women on the transmission of hepatitis B virus (HBV) and HBIG combined immunization in preventing mother-to-child transmission of HBV. METHODS: Fifty-three pregnant women with HBsAg positive for more than 6 months and 53 infants born to them were divided into three groups (> 106 copies / ml, 103-106 copies / ml and <103 Copies / ml 3 groups, all infants within 6 h and 30 d were injected with 200 IU HBIG, respectively, at the same time were born within 24 h, 1 month after birth and 6 months after birth, three times 20 μg of recombinant yeast hepatitis B vaccine . Venous blood HBV markers and HBVDNA levels were measured at the time of delivery and at infancy and 1 year of age in pregnant women. Results: The HBsAg positive rate and titer in serum of HBV DNA> 106 copies / ml group were significantly higher than those of 103 ~ 106 copies / ml and <103 copies / ml Group (P <0.05). The serum HBV DNA levels of all newborns were less than the detection limit (1 000 copies / mL). The positive rate of HBsAg was 9.4% (5/53). There was no significant difference in HBsAg positive rate and titers between the three groups (P> 0.05). With the increase of HBV DNA levels in pregnant women, the positive rate and titer of serum HBeAg in neonates increased accordingly, but the positive rate and titer of anti-HBe decreased correspondingly. There was significant difference between the groups (P <0.05). At 12 months of birth, serum HBsAg and HBeAg were negative in all infants, and serum HBV DNA levels were below the detection limit. Serum levels of anti-HBs in HBV DNA> 106 copies / ml group were significantly lower than 103-106 copies / ml and <103 copies / ml group with P values of 0.021 and 0.011, respectively. Conclusion: The high viral load of pregnant women has a certain impact on the success rate of blocking mother-to-child transmission of hepatitis B.