乙型肝炎免疫球蛋白联合乙肝疫苗治疗对阻断乙型肝炎病毒母婴传播疗效和安全性研究
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摘要
目的:探究乙型肝炎免疫球蛋白(HBIG)联合乙肝疫苗对阻断乙型肝炎病毒(HBV)母婴传播的疗效和安全性。方法:选取2015年2月-2017年2月本院收治的妊娠合并乙型肝炎患者78例。按照住院号尾数单双号将其分成观察组(HBIG+乙肝疫苗)与对照组(乙肝疫苗),各39例。比较两组母婴传播指标、新生儿出生时的发育情况。结果:观察组乙型肝炎病毒表面抗原(HBsAg)阳性率、HBV-DNA阳性率、阻断传播失败率、宫内感染率均低于对照组,乙型肝炎病毒表面抗体(HBsAb)阳性率高于对照组,差异均有统计学意义(P<0.05);两组新生儿性别、身长、体重、头围及新生儿窒息发生率比较,差异均无统计学意义(P>0.05),但观察组新生儿Apgar评分高于对照组(P<0.05)。结论:HBIG联合乙肝疫苗应用于阻断HBV母婴传播,加强新生儿免疫,减少了母婴垂直传播(宫内感染)的发生率,减少了乙型肝炎传播,此方法值得应用与推广。
Objective:To study the efficacy and safety of hepatitis B immune-globulin(HBIG)plus hepatitis B vaccine for interrupting the mother-infant transmission of hepatitis B virus(HBV).Method:A total of 78 pregnant women with hepatitis B admitted to our hospital from February 2015 to February 2017 were selected.According to the final number of hospitalization,they were divided into observation group(HBIG+hepatitis B vaccine)and control group(hepatitis B vaccine),39 cases in each group.The maternal-infant transmission indicators and neonatal development between two groups were compared.Result:The positive rate of hepatitis B virus surface antigen(HBsAg),HBV-DNA,failure rate of blocking transmission,intrauterine infection rate and chronic infection rate in observation group were lower than those of control group,and the positive rate of hepatitis B virus surface antibody(HBsAb)was higher than that of control group,the differences were statistically significant(P<0.05).The sex,length,weight,head circumference and incidence of neonatal asphyxia in two groups were compared,the differences were not statistically significant(P>0.05),but the Apgar score of newborns in observation group was higher than that of control group(P<0.05).Conclusion:HBIG combined with hepatitis B vaccine is used to block mother-infant transmission of HBV,strengthen the immunization of newborns,reduce the incidence of mother-infant transmission(intrauterine infection),and reduce the transmission of hepatitis B,this method is worthy of application and promotion.
Objective:To study the efficacy and safety of hepatitis B immune-globulin(HBIG)plus hepatitis B vaccine for interrupting the mother-infant transmission of hepatitis B virus(HBV).Method:A total of 78 pregnant women with hepatitis B admitted to our hospital from February 2015 to February 2017 were selected.According to the final number of hospitalization,they were divided into observation group(HBIG+hepatitis B vaccine)and control group(hepatitis B vaccine),39 cases in each group.The maternal-infant transmission indicators and neonatal development between two groups were compared.Result:The positive rate of hepatitis B virus surface antigen(HBsAg),HBV-DNA,failure rate of blocking transmission,intrauterine infection rate and chronic infection rate in observation group were lower than those of control group,and the positive rate of hepatitis B virus surface antibody(HBsAb)was higher than that of control group,the differences were statistically significant(P<0.05).The sex,length,weight,head circumference and incidence of neonatal asphyxia in two groups were compared,the differences were not statistically significant(P>0.05),but the Apgar score of newborns in observation group was higher than that of control group(P<0.05).Conclusion:HBIG combined with hepatitis B vaccine is used to block mother-infant transmission of HBV,strengthen the immunization of newborns,reduce the incidence of mother-infant transmission(intrauterine infection),and reduce the transmission of hepatitis B,this method is worthy of application and promotion.
引文
[1]马子东,冯朋,周益文,等.乙型肝炎免疫球蛋白对阻断乙型肝炎病毒母婴传播的疗效和安全性研究[J].蚌埠医学院学报,2014,39(9):1185-1186.
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[4]陆全银.乙型肝炎免疫球蛋白联合乙型肝炎疫苗阻断HBV母婴传播的效果分析[J].临床肝胆病杂志,2015,31(8):1321-1322.
[5]尹雪如,刘志华,刘智泓,等.乙型肝炎病毒母婴零传播:理想与挑战[J].中华肝脏病杂志,2018,26(4):262-265.
[6]姜洁,戴生龙,徐建芳,等.江苏省2010-2015年乙型肝炎母婴阻断效果的随访研究[J].中华流行病学杂志,2016,37(10):1345-1349.
[7]朱桂琴.重组乙型肝炎疫苗联合乙肝免疫球蛋白阻断乙肝母婴传播的效果及相关因素分析[J].中国妇幼保健,2017,32(5):965-968.
[8]Civan J,Hann H W.Giving rituximab in patients with occult or resolved hepatitis B virus infection:are the current guidelines good enough?[J].Expert Opin Drug Saf,2015,14(6):865-875.
[9]包依夏姆·阿巴拜克力,努力比亚·阿不杜克尤木,张跃新,等.乙肝疫苗联合HBIG接种阻断HBsAg/HBeAg双阳性孕妇HBV母婴传播的效果研究[J].实用肝脏病杂志,2017,20(4):481-482.
[10]Tan B,Qin L,Chen C X,et al.Multiplex fluorescence quantitative polymerase chain reaction for simultaneous detection of hepatitis B virus,hepatitis C virus and human immunodeficiency virus[J].Clin Lab,2015,61(1-2):53-59.
[11]黄敏,周海新,郑粼,等.探讨免疫预防乙型肝炎病毒母婴传播的效果及影响因素[J].中华医院感染学杂志,2018,28(17):2670-2672,2676.
[12]Yim S Y,Um S H,Young Jung J,et al.Clinical Significance of Hepatitis B Virus Precore and Core Promoter Variants in Korean Patients With Chronic Hepatitis B[J].J Clin Gastroenterol,2015,49(1):61-68.
[13]孙维会,马磊,郝岸华,等.替比夫定阻断乙型肝炎病毒母婴传播的效果与安全性评价[J].中华肝脏病杂志,2015,23(3):180-183.
[14]Lu S,Xu Y,Mu Q,et al.The risk of hepatitis B virus reactivation and the role of antiviral prophylaxis in hepatitis B surface antigen negative/hepatitis B core antibody positive patients with diffuse large B-cell lymphoma receiving rituximabbased chemotherapy[J].Leuk Lymphoma,2015,56(4):1027-1032.
[15]邓勇,吴维新,张大志,等.替比夫定阻断乙型肝炎病毒母婴传播停药后的安全性研究[J].中华肝脏病杂志,2015,23(8):586-589.
[16]王川,武兴,王崇,等.HBV母婴传播阻断效果及影响因素分析[J].临床肝胆病杂志,2015,31(8):1238-1243.
[17]眭志祥,袁卫建,郑彬,等.丹阳市乙肝疫苗联合免疫球蛋白母婴阻断效果分析[J].实用预防医学,2017,24(4):385-387.
[18]包依夏姆·阿巴拜克力,努力比亚·阿不杜克尤木,张跃新,等.乙肝疫苗联合HBIG接种阻断HBsAg/HBeAg双阳性孕妇HBV母婴传播的效果研究[J].实用肝脏病杂志,2017,20(2):248-249.
[19]Honda T,Ishigami M,Luo F,et al.Hepatitis B e Antigen and Hepatitis B Surface Antigen Seroclearance with the Emergence of Lamivudine-associated and Core Mutations Following CD4Elevation in a Patient with Hepatitis B and HIV[J].Intern Med,2015,54(6):585-590.
[20]金美玉,全顺爱,郑世梅,等.乙型肝炎免疫球蛋白联合乙型肝炎疫苗阻断乙型肝炎病毒母婴传播的研究[J].中华医院感染学杂志,2016,26(10):2354-2356.
[2]李克艳.常规免疫预防阻断HBeAg阴性HBV感染母婴传播的效果及影响因素[J].肝脏,2017,22(2):152-153,186.
[3]徐国荣,柴丽莉.乙肝疫苗联合乙型肝炎免疫球蛋白接种阻断血清HBsAg阳性母亲HBV母婴传播效果分析[J].实用肝脏病杂志,2018,21(6):851-854.
[4]陆全银.乙型肝炎免疫球蛋白联合乙型肝炎疫苗阻断HBV母婴传播的效果分析[J].临床肝胆病杂志,2015,31(8):1321-1322.
[5]尹雪如,刘志华,刘智泓,等.乙型肝炎病毒母婴零传播:理想与挑战[J].中华肝脏病杂志,2018,26(4):262-265.
[6]姜洁,戴生龙,徐建芳,等.江苏省2010-2015年乙型肝炎母婴阻断效果的随访研究[J].中华流行病学杂志,2016,37(10):1345-1349.
[7]朱桂琴.重组乙型肝炎疫苗联合乙肝免疫球蛋白阻断乙肝母婴传播的效果及相关因素分析[J].中国妇幼保健,2017,32(5):965-968.
[8]Civan J,Hann H W.Giving rituximab in patients with occult or resolved hepatitis B virus infection:are the current guidelines good enough?[J].Expert Opin Drug Saf,2015,14(6):865-875.
[9]包依夏姆·阿巴拜克力,努力比亚·阿不杜克尤木,张跃新,等.乙肝疫苗联合HBIG接种阻断HBsAg/HBeAg双阳性孕妇HBV母婴传播的效果研究[J].实用肝脏病杂志,2017,20(4):481-482.
[10]Tan B,Qin L,Chen C X,et al.Multiplex fluorescence quantitative polymerase chain reaction for simultaneous detection of hepatitis B virus,hepatitis C virus and human immunodeficiency virus[J].Clin Lab,2015,61(1-2):53-59.
[11]黄敏,周海新,郑粼,等.探讨免疫预防乙型肝炎病毒母婴传播的效果及影响因素[J].中华医院感染学杂志,2018,28(17):2670-2672,2676.
[12]Yim S Y,Um S H,Young Jung J,et al.Clinical Significance of Hepatitis B Virus Precore and Core Promoter Variants in Korean Patients With Chronic Hepatitis B[J].J Clin Gastroenterol,2015,49(1):61-68.
[13]孙维会,马磊,郝岸华,等.替比夫定阻断乙型肝炎病毒母婴传播的效果与安全性评价[J].中华肝脏病杂志,2015,23(3):180-183.
[14]Lu S,Xu Y,Mu Q,et al.The risk of hepatitis B virus reactivation and the role of antiviral prophylaxis in hepatitis B surface antigen negative/hepatitis B core antibody positive patients with diffuse large B-cell lymphoma receiving rituximabbased chemotherapy[J].Leuk Lymphoma,2015,56(4):1027-1032.
[15]邓勇,吴维新,张大志,等.替比夫定阻断乙型肝炎病毒母婴传播停药后的安全性研究[J].中华肝脏病杂志,2015,23(8):586-589.
[16]王川,武兴,王崇,等.HBV母婴传播阻断效果及影响因素分析[J].临床肝胆病杂志,2015,31(8):1238-1243.
[17]眭志祥,袁卫建,郑彬,等.丹阳市乙肝疫苗联合免疫球蛋白母婴阻断效果分析[J].实用预防医学,2017,24(4):385-387.
[18]包依夏姆·阿巴拜克力,努力比亚·阿不杜克尤木,张跃新,等.乙肝疫苗联合HBIG接种阻断HBsAg/HBeAg双阳性孕妇HBV母婴传播的效果研究[J].实用肝脏病杂志,2017,20(2):248-249.
[19]Honda T,Ishigami M,Luo F,et al.Hepatitis B e Antigen and Hepatitis B Surface Antigen Seroclearance with the Emergence of Lamivudine-associated and Core Mutations Following CD4Elevation in a Patient with Hepatitis B and HIV[J].Intern Med,2015,54(6):585-590.
[20]金美玉,全顺爱,郑世梅,等.乙型肝炎免疫球蛋白联合乙型肝炎疫苗阻断乙型肝炎病毒母婴传播的研究[J].中华医院感染学杂志,2016,26(10):2354-2356.