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目的:探讨乙肝免疫球蛋白(HBIg)联合替比夫定对乙肝表面抗原(HBs Ag)阳性孕妇母婴传播的阻断效果。方法:根据自愿原则将该院产科门诊收集的330例HBs Ag阳性、HBV-DNA定量≥1×106copies/ml孕妇分为研究组(246例)和对照组(84例),研究组孕妇分别于孕第28、32、36周注射200 IU HBIg,同时口服替比夫定至分娩,对照组孕妇仅注射HBIg,未口服替比夫定。两组新生儿均出生后注射200 IU HBIg,分别于出生后6 h、第1个月、第6个月注射乙肝疫苗10μg,比较两组新生儿出生后及出生1年后的免疫学指标差异。结果:对两组新生儿的出生体重、身长、1 min Apgar、性别等指标情况进行统计分析差异无统计学意义(P>0.05),研究组新生儿的宫内感染率为6.1%显著低于对照组的16.67%(χ2=8.727,P=0.003),研究组新生儿的HBV-DNA阳性率为1.22%显著低于对照组的11.9%(χ2=18.893,P=0.000),研究组新生儿的HBs Ab阳性率为22.36%显著高于对照组的4.76%(χ2=13.205,P=0.000),研究组的HBs Ab阳转率为95.8%显著高于对照组的87.5%(χ2=6.281,P=0.012)。结论:HBIg联合替比夫定能够有效阻断高病毒载量HBs Ag阳性孕妇的母婴传播。
Objective: To investigate the blocking effect of hepatitis B immunoglobulin (HBIg) and telbivudine on mother-to-infant transmission of hepatitis B surface antigen (HBsAg) positive pregnant women. Methods: According to the principle of voluntariness, 330 HBsAg-positive and HBV-DNA≥1 × 106copies / ml pregnant women were divided into study group (246 cases) and control group (84 cases) At the 28th, 32nd and 36th weeks of pregnancy, 200 IU HBIg was injected, and telbivudine was given orally at the same time. Pregnant women in control group only received HBIg and did not take telbivudine orally. Neonates of both groups were injected with 200 IU HBIg after birth, and 10 μg of hepatitis B vaccine was injected respectively at 6 h, 1 month and 6 months after birth. The differences of immunological indexes between the two groups after birth and one year after birth were compared . Results: There was no significant difference in birth weight, body length, 1 min Apgar, gender and other indicators between the two groups (P> 0.05). The intrauterine infection rate of newborns in study group was 6.1% The positive rate of HBV-DNA in neonates in study group was 1.22%, which was significantly lower than that in control group (χ2 = 8.727, P = 0.0003) (16.67% (Χ2 = 13.205, P = 0.000). The positive rate of HBs Ab in the study group was 95.8%, which was significantly higher than 87.5% of the control group (χ2 = 6.281, P = 0.012). Conclusion: HBIg combined with Telbivudine can effectively block mother-to-child transmission of HBsAg-positive pregnant women with high viral load.