摘要
目的:探讨妊娠晚期孕妇口服替诺福韦联合新生儿主、被动免疫对阻断乙型肝炎病毒(HBV)母婴传播的效果。方法:选择2019年3月至2021年12月在平南县人民医院进行定期孕检且HBV载量>1×106IU/mL的孕妇为研究对象,共80例,分为治疗组和对照组。治疗组孕妇自产前28~32周开始口服替诺福韦,且新生儿出生后6 h内肌内注射100 IU高效乙肝免疫球蛋白(HBIG)+0、1、6个月肌内注射10μg乙肝疫苗,对照组孕妇不予治疗,其新生儿主、被动免疫同治疗组,观察两组孕妇产前病毒载量的变化及新生儿免疫保护效果。结果:两组孕妇孕28周6前HBV载量为2.72×10~8.99×108IU/mL。治疗组用药第6周(孕34~38周)HBV载量显著下降(P<0.05),均低于1×106IU/mL;对照组(孕34~38周)HBV载量与孕28周前相比无显著性变化(P>0.05)。两组7~12月龄婴儿的HBsAb阳性率相比无显著性差异(P>0.05)。治疗组7~12月龄婴儿HBV阻断的成功率为100%(50/50),对照组7~12月龄婴儿中有3例HBsAg阳性,阻断成功率为90%(27/30)。结论:妊娠晚期孕妇口服替诺福韦联合新生儿主、被动免疫(乙肝疫苗+HBIG)可有效阻断HBV母婴传播。
Objective:To investigate the effect of oral tenofovir combined with neonatal active and passive immunization on blocking mother-to-child transmission of hepatitis B virus(HBV)in the third trimester of pregnancy.Methods:A total of 80 pregnant women with HBV load>1×106IU/mL who underwent regular pregnancy examination in Pingnan County People’s Hospital from March 2019 to December 2021 were selected as the study subjects,and were divided into treatment group and control group.The pregnant women in the treatment group began to take tenofovir orally 28-32 weeks before delivery,and the newborns were intramuscular injected with 100 IU high potency Hepatitis B immunoglobulin(HBIG)+0,1,6 months intramuscular injection of 10μg hepatitis B vaccine.The pregnant women in the control group were not treated,and their newborns were immunized with active and passive immunization as in the treatment group.The changes of prenatal viral load and neonatal immune protection were observed in the two groups.Results:HBV load before 28 weeks of pregnancy in both 68 groups was 2.72×10~8.99×10 copies/mL.HBV load in the treatment group decreased significantly(P<0.05)at the 6th week(34-38 weeks of pregnancy),all of which were lower than 1×106IU/mL.There was no significant change in HBV load in the control group(34-38 weeks gestation)compared with 28 weeks gestation(P>0.05).There was no significant difference in the positive rate of HBsAb between the two groups(P>0.05).In the treatment group,the success rate of HBV blocking was 100%(50/50),while in the control group,there were 3 HBsAg positive cases in infants aged 7-12 months,and the success rate was 90%(27/30).Conclusion:Oral tenofovir combined with neonatal active and passive immunization(HBV vaccine+HBIG)can effectively block mother-to-child transmission of HBV.
作者
覃萍
王学燕
张陆娟
梁日容
杨海颂
QIN Ping;WANG Xueyan;ZHANG Lujuan;LIANG Rirong;YANG Haisong(Department of Obstetrics,Pingnan People’s Hospital,Guigang 537300,Guangxi,China;Guangxi Key Laboratory of Viral Hepatitis Prevention and Control,Guangxi Center for Disease Control and Prevention,Nanning 530028,Guangxi,China)
基金
广西重点研发计划(项目编号2018AB59002)。
关键词
乙型肝炎病毒
母婴阻断
替诺福韦
乙肝疫苗
乙肝免疫球蛋白
Hepatitis B virus
Mother-to-child blocking
Tenofovir
Hepatitis B vaccine
Hepatitis B immunoglobulin
