乙型肝炎病毒母婴阻断效果评价与影响因素分析—乙型肝炎疫苗与乙型肝炎免疫球蛋白联合免疫阻断研究
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摘要
目的：
评价重组乙型肝炎疫苗(Hepatitis B vaccines, HepB)单纯免疫及其与乙型肝炎免疫球蛋白(Hepatitis B Immune Globulin, HBIG)联合免疫阻断乙肝病毒(Hepatitis B Virus, HBV)母婴传播效果,并分析阻断HBV母婴传播的影响因素。
研究方法：
采用前瞻性队列研究的方法,选择云南省2011年1月-2011年2月期间住院分娩HBsAg阳性母亲及新生儿为研究对象,将出生24小时内接种10μg重组HepB和HBIG的新生儿作为联合免疫组,接种10gg重组HepB的新生儿作为单纯免疫组,各组均按照0、1、6个月的免疫程序接种10μg重组HepB,定期对各组母亲及婴儿进行个案调查,婴儿全程免疫结束后1月(7-12月龄)随访采集静脉血检测乙肝感染标志物,随访时间截止到2011年12月。用疫苗的保护率来评价重组HepB(酵母)与HBIG联合免疫阻断HBV母婴传播效果,并分析母亲感染状态、分娩方式、分娩医院级别、母乳喂养、婴儿是否联合免疫等因素对阻断HBV母婴传播的影响。
结果：
双阳母亲,婴儿联合免疫和单纯免疫HBsAg阳性率分别为5.1%、14.1%(x2=4.422,P=0.035),保护率分别为94%、83.4%；单阳母亲婴儿是否联合免疫HBsAg阳性率差异无统计学意义(校正χ2=1.287,P=0.257)；单纯免疫下双阳和单阳母亲其婴儿HBsAg阳性率分别为14.1%、4.1%(χ2=4.227,P=0.04),保护率分别为83.4%、89.7%,而联合免疫下双阳和单阳母亲其婴儿HBsAg阳性率差异无统计学意义(校正χ2=3.28,P=0.07)。影响阻断HBV母婴传播的主要因素为母亲感染状态(OR=5.01,95％CI:1.714～14.669)和婴儿是否联合免疫(OR=3.605,95％CI:1.385～9.381),母亲孕期使用HBIG、分娩方式、分娩医院级别、喂养方式、婴儿性别等因素对阻断HBV母婴传播的无影响。
结论：
双阳母亲的婴儿采用联合免疫阻断HBV母婴传播效果更佳,而单阳母亲的婴儿是否联合免疫其阻断效果相同；在单纯免疫下,双阳母亲其婴儿感染风险高于单阳；母亲HBV感染状态和婴儿是否联合免疫是影响婴儿HBsAg阳性率的两个主要因素。
Objectives:To evaluate the protective efficacy in preventing mother-to-infant transmission of Hepatitis B Virus(HBV) with immunization of Recombinant Yeast Hepatitis B vaccines(HepB)(10μg) and HepB(10μg)combination with Hepatitis B immune globulin(HBIG), And to explore the factors in preventing mother-to-infant transmission of HBV.
Methods:This study was a prospective cohort study. In Yunnan Province, we selected mothers whose infants were born from January through February2011, and HBsAg were positive when they were pregnant or child-bearing.The newborns were divided into groups A and B, which infants in groups A were immuned with HepB within24hours after their birth, and infants in groups B were immuned with HepB and HBIG within24hours after their birth. The regular schedule of HepB immunization was0,1st, and6th month with the dose was10μg. The information about HBV infection of mothers and infants, and recodes of HepB immunization of infants, were collected by the fixed questionnaires. The Serum of the children in cohort would be collected in one month after the full dose immunization following a laboratory test of the HBV infection indicators. The end point of this research was on December31,2011. Protective efficacy was estimated using series of formulas. The factors, such as mother's HBV infecting status, delivery mode, breast feeding, and immuned with HepB and HBIG or with HepB only, were analysed with Logistic regression.
Results:For mothers whose both HBsAg and HBeAg were positive, the HBsAg positive rate and the protective rate was14.1%and83.4%for the infants vaccinated with HBIG, and5.1%and94%for the infants vaccinated without HBIG (χ2=4.422,P value=0.035).For mothers with only the HBsAg positive,the difference was no significant between the group combination with HBIG and without HBIG(continuity correctionχ2=1.287,P value=0.257). For the children vaccinated with HepB only, the HBsAg positive rate and the protective rate was14.1%and83.4%for the infants whose mother both HBsAg and HBeAg positive, and was4.1%and89.7%for the mother only HBsAg positive (χ2=4.227,P value=0.04). For the children vaccinated with HepB and HBIG, the difference was no significant between the mother both HBsAg and HBeAg were positive and only HBsAg (continuity correctionχ2=3.28, P value=0.07).Results from multi-factors analysis showed that mother's HBV infecting status(OR=5.01,95%CI:1.714-14.669)and combination with HBIG (OR=3.605,95%CI:1.385～9.381) were the important influencing factors of recombinant yeastderived HepB in preventing mother-to-infant transmission of HBV. While HBIG inoculation in pregnant women, delivery mode, level of hospital, breast feeding and gender were not the factors.
Conclusions:For mothers both HBsAg and HBeAg positive, the protective efficacy are better for the infants vaccinated with HepB and HBIG, while the protective efficacy had no difference for the infants whose mother was only HBsAg positive. For infants vaccinated with only HepB, they had high risk whose mother both HBsAg and HBeAg were positive.
评价重组乙型肝炎疫苗(Hepatitis B vaccines, HepB)单纯免疫及其与乙型肝炎免疫球蛋白(Hepatitis B Immune Globulin, HBIG)联合免疫阻断乙肝病毒(Hepatitis B Virus, HBV)母婴传播效果,并分析阻断HBV母婴传播的影响因素。
研究方法：
采用前瞻性队列研究的方法,选择云南省2011年1月-2011年2月期间住院分娩HBsAg阳性母亲及新生儿为研究对象,将出生24小时内接种10μg重组HepB和HBIG的新生儿作为联合免疫组,接种10gg重组HepB的新生儿作为单纯免疫组,各组均按照0、1、6个月的免疫程序接种10μg重组HepB,定期对各组母亲及婴儿进行个案调查,婴儿全程免疫结束后1月(7-12月龄)随访采集静脉血检测乙肝感染标志物,随访时间截止到2011年12月。用疫苗的保护率来评价重组HepB(酵母)与HBIG联合免疫阻断HBV母婴传播效果,并分析母亲感染状态、分娩方式、分娩医院级别、母乳喂养、婴儿是否联合免疫等因素对阻断HBV母婴传播的影响。
结果：
双阳母亲,婴儿联合免疫和单纯免疫HBsAg阳性率分别为5.1%、14.1%(x2=4.422,P=0.035),保护率分别为94%、83.4%；单阳母亲婴儿是否联合免疫HBsAg阳性率差异无统计学意义(校正χ2=1.287,P=0.257)；单纯免疫下双阳和单阳母亲其婴儿HBsAg阳性率分别为14.1%、4.1%(χ2=4.227,P=0.04),保护率分别为83.4%、89.7%,而联合免疫下双阳和单阳母亲其婴儿HBsAg阳性率差异无统计学意义(校正χ2=3.28,P=0.07)。影响阻断HBV母婴传播的主要因素为母亲感染状态(OR=5.01,95％CI:1.714～14.669)和婴儿是否联合免疫(OR=3.605,95％CI:1.385～9.381),母亲孕期使用HBIG、分娩方式、分娩医院级别、喂养方式、婴儿性别等因素对阻断HBV母婴传播的无影响。
结论：
双阳母亲的婴儿采用联合免疫阻断HBV母婴传播效果更佳,而单阳母亲的婴儿是否联合免疫其阻断效果相同；在单纯免疫下,双阳母亲其婴儿感染风险高于单阳；母亲HBV感染状态和婴儿是否联合免疫是影响婴儿HBsAg阳性率的两个主要因素。
Objectives:To evaluate the protective efficacy in preventing mother-to-infant transmission of Hepatitis B Virus(HBV) with immunization of Recombinant Yeast Hepatitis B vaccines(HepB)(10μg) and HepB(10μg)combination with Hepatitis B immune globulin(HBIG), And to explore the factors in preventing mother-to-infant transmission of HBV.
Methods:This study was a prospective cohort study. In Yunnan Province, we selected mothers whose infants were born from January through February2011, and HBsAg were positive when they were pregnant or child-bearing.The newborns were divided into groups A and B, which infants in groups A were immuned with HepB within24hours after their birth, and infants in groups B were immuned with HepB and HBIG within24hours after their birth. The regular schedule of HepB immunization was0,1st, and6th month with the dose was10μg. The information about HBV infection of mothers and infants, and recodes of HepB immunization of infants, were collected by the fixed questionnaires. The Serum of the children in cohort would be collected in one month after the full dose immunization following a laboratory test of the HBV infection indicators. The end point of this research was on December31,2011. Protective efficacy was estimated using series of formulas. The factors, such as mother's HBV infecting status, delivery mode, breast feeding, and immuned with HepB and HBIG or with HepB only, were analysed with Logistic regression.
Results:For mothers whose both HBsAg and HBeAg were positive, the HBsAg positive rate and the protective rate was14.1%and83.4%for the infants vaccinated with HBIG, and5.1%and94%for the infants vaccinated without HBIG (χ2=4.422,P value=0.035).For mothers with only the HBsAg positive,the difference was no significant between the group combination with HBIG and without HBIG(continuity correctionχ2=1.287,P value=0.257). For the children vaccinated with HepB only, the HBsAg positive rate and the protective rate was14.1%and83.4%for the infants whose mother both HBsAg and HBeAg positive, and was4.1%and89.7%for the mother only HBsAg positive (χ2=4.227,P value=0.04). For the children vaccinated with HepB and HBIG, the difference was no significant between the mother both HBsAg and HBeAg were positive and only HBsAg (continuity correctionχ2=3.28, P value=0.07).Results from multi-factors analysis showed that mother's HBV infecting status(OR=5.01,95%CI:1.714-14.669)and combination with HBIG (OR=3.605,95%CI:1.385～9.381) were the important influencing factors of recombinant yeastderived HepB in preventing mother-to-infant transmission of HBV. While HBIG inoculation in pregnant women, delivery mode, level of hospital, breast feeding and gender were not the factors.
Conclusions:For mothers both HBsAg and HBeAg positive, the protective efficacy are better for the infants vaccinated with HepB and HBIG, while the protective efficacy had no difference for the infants whose mother was only HBsAg positive. For infants vaccinated with only HepB, they had high risk whose mother both HBsAg and HBeAg were positive.
引文
[1]Ganem D,Prince AM. Hepatitis B virus infection-natural history and clinical consequences [J]. N Eng I J Med,2004,350(11):1118-29.
[2]Kew MC.Geographical Symposium on Viral Hepatitis and Liver Disease Proceeding Books [M].2004:216-221.
[3]Goldstein ST et al. A mathematical model to estimate global hepatitis B disease burden and vaccination impact [J]. International Journal of Epidemiology,2005,34:1329-1339.
[4]Beasley RP et al. Prevention of perinatally transmitted hepatitis B virus infections with hepatitis B immuneglobulin and hepatitis B vaccine [J]. Lancet,1983,2:1099-1102.
[5]Wong VC et al. Prevention of the HBsAg carrier state in newborn infants of mothers who are chronic carriers of HBsAg and HBeAg by administration of hepatitis-B vaccine and hepatitis-B immunoglobulin. Double-blind randomised placebo-controlled study [J]. Lancet, 1984,1:921-926.
[6]de la Hoz F et al. Eight years of hepatitis B vaccination in Colombia with a recombinant vaccine:factors influencing hepatitis B virus infection and effectiveness [J]. International Journal of Infectious Diseases,2008,12:183-189.
[7]Goldstein ST at al. Incidence and risk factors for acute hepatitis B in the United States, 1982-1998:implications for vaccination programs [J]. Journal of Infectious Diseases, 2002,185:713-719.
[8]乐杰,谢辛,林仲秋,等.妇产科学[M]第7版.北京：人民卫生出版,2008：145-149.
[9]张先艳,张小娟,薛艳霞.乙肝病毒母婴垂直传播的阻断措施[J].延安大学学报(医学科学版),2005,3(2)：31.
[10]贾继东.孕妇注射乙型肝炎免疫球蛋白预防乙型肝炎病毒母婴传播的有关问题[J].中华内
科杂志,2007,46(5)：360-361.
[11]Margolis HS et al. Prevention of hepatitis B virus transmission by immunization. An economic analysis of current recommendations [J]. Journal of the American Medical Association,1995,274:1201-1208.
[12]祁国明.中国病毒性肝炎血清流行病学调查[M].北京：科学技术文献,1997：39-60.
[13]陈园生,梁晓峰,陈丽娟,等.中国儿童乙型肝炎疫苗预防接种效果分析[J].中国计划免 疫,2006,12(2)：85-86.
[14]Liang X, Bi S, Yang W, et al. Epidemiological serosurvey of hepatitis B in China--declining HBV prevalence due to hepatitis B vaccination [J]. Vaccine,2009,27(47):6550-7.
[15]Liang X, Bi S, Yang W, et al. Evaluation of the impact of hepatitis B vaccination among children born during 1992-2005 in China. J Infect Dis,2009,200(1):39-47.
[16]朱科伦,朱郇悯,曾文铤.乙型肝炎流行病学的研究新进展[J].广州医药,2010,41(4)：1-2.
[17]Lu FM, Zhuang H. Management of hepatitis B in China [J]. Chin Med J (Engl), 2009,122(1):3-4.
[18]朱启镕.乙型肝炎病毒的母婴传播与阻断研究[J].上海预防医学杂志,2005,17(9)：419.
[19]许红梅,刘作义.乙型肝炎病毒母婴传播及其阻断[J].实用儿科临床杂志,2005,20(9)：835.
[20]骆抗先.乙型肝炎基础与临床[M].北京：人民卫生出版社,1997：233.
[21]谢新宝.乙型肝炎病毒母婴传播和预防研究进展[J].国外医学儿科分册2004,31(5)：225.
[22]Hyams KC.Risks of chronicity following acute hepatitis B virus infection:a review [J]. Clinical Infectious Diseases,1995,20:992-1000.
[23]徐道振,巫善明,周霞秋,等.病毒性肝炎临床实践[M].北京：人民卫生出版社,2006：21.
[24]陈凡金,盛振东,张贻庆HBIG阻断乙肝母婴传播对乙肝疫苗免疫成功率的影响[J].中国热带医学,2010,10,(2)：171-172.
[25]Hieu NT,K.im KH,Janowicz z,et al.Comparative efficacy,safety and imunogenicity of Hepavax-Gene and Engerix-B,recombinant hepatitis B Vaccines,in infants bRRn to HBsAg and HBeAg positive mothers in Vietnam:an assessment at 2 years[J].Vaccine,2002,20:1803.
[26]杨小梅.乙型肝炎病毒母婴传播[J].热带医学杂志,2009,9(9)：1190-1191.
[27]European Association for the Study of the Liver.EASL Clinical Practice Guidelines: Management of chronic hepatitis B[J].J Hepatol,2009,50:227-242.
[28]中华医学会肝病学分会,中华医学会感染病学.慢性乙肝防治指南[M].
[29]王富珍,龚晓红,李辉.北京市乙肝疫苗母婴阻断效果监测分析[J].中国计划免疫,2006,12,97-99.
[30]夏国良,龚健,王继杰,等.重组乙型肝炎疫苗阻断乙型肝炎病毒母婴传播方案的保护效果[J].中华流行病学杂志,2003,24(5)：362-364.
[31]Lok AS, McMahon BJ. AASLD practice guidelines. Chronic hepatitis B:update 2009. Hepatology,2009,50:1-36.
[32]Shi Z,Li X,Ma L,et al.Hepatitis B immunoglobulin injection in pregnancy to interrupt hepatitis B virus mother -to-child transmission -a meta -analysis[J].Int J Infect Dis,2010,14(7): 622-634.
[33]董悦.《慢性乙型肝炎防治指南》中阻断母婴传播的相关内容[J].中华围产医学杂志,2006,9(5)：360.
[34]朱云霞,邹怀宾,等.不同分娩方式对阻断乙型肝炎病毒母婴传播的影响[J].山西医科大学学报(J Shanx iM ed Univ),2010,41(6):495-496.
[35]李继军,王富珍,郑徽,等.不同分娩方式对乙型肝炎病毒母婴传播的影响[J].中国计划免疫,2007,13(4)：306-308.
[36]纪向虹,戚红.不同分娩方式对HBV母婴传播的影响[J].山东医药,2002,42(15)：18-19.
[37]Wang J,Zhu Q,Zhang X.Effect of delivery mode on maternal-infant transmission of hepatitis B virus by immunoprophylaxis[J]. Chin Med J,2002,115(10):1510-1512.
[38]Xu DZ,Yan YP.Choi BC,et a 1.Risk factors and mechanism of transplacental
transmission of hepatitis B virus:a case-control study [J].J Med Virol,2002,67:20-6.
[39]曹鲁泉,田丹,陶靖,等.452例乙型肝炎病毒血清学标志物阳性孕妇母乳乙型肝炎病毒DNA分析[J].中国优生与遗传杂志,2006,14(3)：86-87.
[40]王富兰,张建华.乙型肝炎病毒携带产妇的母乳喂养现状及对策[J].重庆医科大学报,2003,28(2)：254-256.
[41]Petrova M,Kamburov V.Breastfeeding and chronic HBV infection: Clinical and social implications[J].World J Gastroenterol,2010,16(40):5042-5046.
[42]崔富强,王富珍,郑徽,等.接种不同剂量重组乙型肝炎疫苗(酵母)阻断乙型肝炎病毒母婴传播的评价[J].中国计划免疫,2007,13(4)：289-292.
[43]WHO.Hepatitis B Vaccines[J].WER,2004,28(79):255-263.
[44]卫生部政策法规司卫生政务通报第15期(2005年6月16日).
[45]YAN Kai-hua, LI Li-li, CHEN Shu-ying,et al. Assessment of effect of HBIG combined with hepatitis B vaccine in interrupting vertical transmission of HBV from mothers to babies[J].China Tropical Medicine,2009,3:58-60.
[46]王富珍,崔富强,郑徽等.重组乙型肝炎疫苗(酵母)与乙型肝炎免疫球蛋白联合免疫阻断乙型肝炎病毒母婴传播的效果分析[J].中国计划免疫,2007,13(4)：293-297.
[47]Xu WM,Cui YT,Wang L,et al.Lamivudine in late pregnancy to prevent perinatal transmission of hepatitis B virus infection:a multicentre,randomized,double-blind,placebo -controlled study[J].J Viral Hepat,2009,16(2):94-103.
[48]孙莲英,庞志钊,张文英,等.不同剂量重组乙型肝炎疫苗(酵母)阻断乙型肝炎病毒母婴传播的研究[J].中国计划免疫,2006,12(4)：262-263.
[49]李强,赵月.重组酵母乙肝疫苗与乙肝免疫球蛋白联合对乙肝母婴传播阻断效果观察[J].中国社区医师,2011,163(277)：117.
[50]Hammitt LL et al. Hepatitis B immunity in children vaccinated with recombinant hepatitis B vaccine beginning at birth: a follow-up study at 15 years. Vaccine,2007,25:6958-6964.
[51]彭文伟,传染病学[M]第4版.z北京：人民卫生出版社,2004：40-41.
[52]袁国平,李明珠,于科.乙肝疫苗联合免疫球蛋白阻断母婴传播效果[J].中国公共卫生2009,25(12)：1479-1480.
[53]Wiseman E, Fraser MA, Holden S, et al Perinatal transmission of hepatitis B virus:an Australian experience [J].Med J Aust,2009,190(9):489-92.
[54]冯永亮,王素萍,魏俊妮等.乙型肝炎病毒宫内感染危险因素研究[J].中华流行病学杂志,2008,29(2)：132-135.
[55]李克勇,刘沛.乙型肝炎疫苗和乙型肝炎免疫球蛋白联合应用阻断乙型肝炎病毒母婴传播的分析[J].东南大学学报(医学版),2007,26(1)：43-44.
[56]宋婷婷,单芙香,程锦泉,等.乙肝疫苗和免疫球蛋白阻断乙肝母婴传播效果研究[J].中华疾病控制杂志,2011,15(6)：497-499.
[57]岳亚飞,杨晓菊,张树林,等.乙肝表面抗原阳性孕妇肌注乙肝免疫球蛋白预防母婴传播的临床研究[J].中国实用妇科与产科杂志,1999,15(5)：547-549.
[58]王建设,朱启镕,张秀珍.分娩方式对乙型肝炎病毒母婴传播阻断效果的影响.中华医学杂志,2001,81：108.
[59]陈红,任杰,刘晓红.不同分娩方式对乙型肝炎病毒母婴传播的影响.中国妇幼健康研究,2008,19：214-216.
[60]张绍芳,刘杰波,张爱香.分娩与阻断方式对HBV母婴垂直传播的影响[J].现代预防医学,2005,32(8)：933.
[61]曹鲁泉,田丹,陶靖,等.452例乙型肝炎病毒血清学标志物阳性孕妇母乳乙型肝炎病毒DNA分析[J].中国优生与遗传杂志,2006,14(3)：86-87.
[62]王谢桐,于恩燕.妊妊娠合并乙型病毒性肝炎的母婴传播与阻断[J].实用妇产科杂志,2010, 26(4)：244-246.
[63]段恕诚,朱启,吕晴,等.乙肝疫苗对宫内感染的初步研究..临床儿科杂志,1993,18(11)：1492-1500.
[1]Ganem D,Prince AM. Hepatitis B virus infection-natural history and clinical consequences [J]. N Eng l J Med,2004,350(11):1118-29.
[2]Kew MC.Geographical Symposium on Viral Hepatitis and Liver Disease Proceeding Books [M].2004:216-221.
[3]Goldstein ST et al. A mathematical model to estimate global hepatitis B disease burden and vaccination impact [J]. International Journal of Epiderniology,2005,34:1329-1339.
[4]Beasley RP et al. Prevention of perinatally transmitted hepatitis B virus infections with hepatitis B immuneglobulin and hepatitis B vaccine [J]. Lancet,1983,2:1099-1102.
[5]Wong VC et al. Prevention of the HBsAg carrier state in newborn infants of mothers who are chronic carriers of HBsAg and HBeAg by administration of hepatitis-B vaccine and hepatitis-B immunoglobulin. Double-blind randomised placebo-controlled study [J]. Lancet, 1984,1:921-926.
[6]de la Hoz F et al. Eight years of hepatitis B vaccination in Colombia with a recombinant vaccine: factors influencing hepatitis B virus infection and effectiveness [J]. International Journal of Infectious Diseases,2008,12:183-189.
[7]Goldstein ST at al. Incidence and risk factors for acute hepatitis B in the United States, 1982-1998:implications for vaccination programs [J]. Journal of Infectious Diseases, 2002,185:713-719.
[8]乐杰,谢辛,林仲秋,等.妇产科学[M]第7版.北京：人民卫生出版,2008：145-149.
[9]张先艳,张小娟,薛艳霞.乙肝病毒母婴垂直传播的阻断措施[J].延安大学学报(医学科学版),2005,3(2)：31.
[10]贾继东.孕妇注射乙型肝炎免疫球蛋白预防乙型肝炎病毒母婴传播的有关问题[J].中华内科杂志,2007,46(5)：360-361.
[11]Margolis HS et al. Prevention of hepatitis B virus transmission by immunization. An economic analysis of current recommendations [J]. Journal of the American Medical Association,1995,274:1201-1208.
[12]祁国明.中国病毒性肝炎血清流行病学调查[M].北京：科学技术文献,1997：39-60.
[13]陈园生,梁晓峰,陈丽娟,等.中国儿童乙型肝炎疫苗预防接种效果分析[J].中国计划免 疫,2006,12(2)：85-86.
[14]Liang X, Bi S, Yang W, et al. Epidemiological serosurvey of hepatitis B in China--declining
HBV prevalence due to hepatitis B vaccination [J]. Vaccine,2009,27(47):6550-7.
[15]Liang X, Bi S, Yang W, et al. Evaluation of the impact of hepatitis B vaccination among
children born during 1992-2005 in China. J Infect Dis,2009,200(1):39-47.
[16]朱科伦,朱郇悯,曾文铤.乙型肝炎流行病学的研究新进展[J].广州医药,2010,41(4)：1-2.
[17]Lu FM, Zhuang H. Management of hepatitis B in China [J]. Chin Med J (Engl), 2009,122(1):3-4.
[18]朱启镕.乙型肝炎病毒的母婴传播与阻断研究[J].上海预防医学杂志,2005,17(9)：4]9.
[19]许红梅,刘作义.乙型肝炎病毒母婴传播及其阻断[J].实用儿科临床杂志,2005,20(9)：835.[20]骆抗先.乙型肝炎基础与临床[M].北京：人民卫生出版社,1997：233.
[21]谢新宝.乙型肝炎病毒母婴传播和预防研究进展[J].国外医学儿科分册,2004,31(5)：225.
[22]Hyams KC.Risks of chronicity following acute hepatitis B virus infection:a review [J]. Clinical Infectious Diseases,1995,20:992-1000.
[23]徐道振,巫善明,周霞秋,等.病毒性肝炎临床实践[M].北京：人民卫生出版社,2006：21.
[24]陈凡金,盛振东,张贻庆HB1G阻断乙肝母婴传播对乙肝疫苗免疫成功率的影响[J].中国热带医学,2010,10,(2)：171-172.
[25]Hieu NT,Kim KH,Janowicz z,et a 1.Comparative efficacy,safety and imunogenicity of Hepavax-Gene and Engerix-B,recombinant hepatitis B Vaccines,in infants bRRn to HBsAg and HBeAg positive mothers in Vietnam:an assessment at 2 years[J].Vaccine,2002,20:1803.
[26]XU DZ,YAN YP.CHOI BC,et al. Risk factors and mechanism of transplacental transmission of hepatitis B virus:a case2cont rol study[J]. J Mcd Virol,2002,67 (20):226.
[27]Ohto H,Lin H, Kaw ana T,et al. Intrauterine transmission of hepatitis B virus is closely related to placcntal leakage[J]. Journal ofth e M edical Virology,1987,21(1):1-6.
[28]闫永平,徐德忠,徐剑秋,等.乙型肝炎病毒宫内传播机制的分子流行病学研究[J].中华流行病学杂志,1998,19(3)：131-133.
[29]朱云霞,邹怀宾,等.不同分娩方式对阻断乙型肝炎病毒母婴传播的影响[J].山西医科大学学报(J Shanx iMed Univ),2010,41(6):495-496.
[30]郦爱贞,肖小敏.乙肝病毒宫内感染临床诊断标准的探讨[J].中国妇幼保健,2007,22(4)：475-477.
[31]Wang J,Sun L. Study on the cellular molecular mechanism of intrauterine transmission of HBV [J]. Journal of Najing Medical University,2003,17,17(5):243.
[32]马力,赵桂珍,曲以琴,等.乙肝病毒携带母亲乳汁中HBsAg/HBeAg与HBV DNA检测结果相关性的探讨[J].中国医科大学学报,1997,26(6)：645-6.
[33]李健,倪季军,乙型肝炎病毒母婴传问题探讨[J].厦门大学学报：自然科学版,2000,39(6)：869-872.
[34]岳瑛,何净,乐杰,等.乙型肝炎病毒血清学标志物阳性的产妇乳汁母婴传播的研究[J].中国妇幼保健,1997,12(3)：166-167.
[35]张兰英,付金凤,李晓平,等.HBV携带者首次初乳和24小时后母乳HBV-DNA携带情况比较[J].中国妇幼保健,1999,14(7)：445-446.
[36]李顿华,姚琪纬,陈颖,等.联合免疫后HBV携带者母乳喂养的安全性研究[J].第七届全国小儿肝病学术会议论文集,2003：20.
[37]彭文伟.病毒性肝炎研究[M].广东科技出版社,1998：25.
[38]沈菁,潘敏,杨丽娟,等.乙肝血清学阳性产妇乳汁中乙肝病毒检测及母婴传播的研究[J].广西医科大学学报,2005,22(1)：76.
[39]林静吟,许岸高,袁建寰,等.乙肝病毒母婴传播的可能途径研究[J].中国实用妇科和产科杂志,1999,15：424-426.
[40]石理兰,张琳,赵桂珍.妊娠合并乙肝病毒感染的流行病学研究进展中国实用妇科与产科杂志[J].2004,20(2)：119-121.
[41]封秀红,王春俭,刁琳琪,等.乙肝疫苗阻断乙肝围产期传播的长期效果研究,1999,15(8)：694.
[42]龚晓红,刘立荣,裴红生,等.北京地区HBsAg口性母亲的儿童乙型肝炎疫苗免疫后血清学监测结果分析[J].中国计划免疫,2000,6(6)：366-368.
[43]卫生部.2004全年计划免疫综合审评报告[M].北京：人民卫生出版社,2005：17.
[44]Shi Z,Li X,Ma L,et al. Hepatitis B immunoglobulin injection in pregnancy to interrupt hepatitis B virus mother -to -child transmission -a meta -analysis[J].Int J Infect Dis,2010,14(7): e622-634.
[45]岳亚飞,杨晓菊,张树林,等.乙肝表面抗原阳性孕妇肌注乙肝免疫球蛋白预防母婴传播的临床研究[J].中国实用妇科与产科杂志,1999,15(9)：547-549.
[46]董悦.《慢性乙型肝炎防治指南》中阻断母婴传播的相关内容[J].中华围产医学杂 志,2006,9(5)：360.
[47]李继军,王富珍,郑徽,等.不同分娩方式对乙型肝炎病毒母婴传播的影响[J].中国计划免疫,2007,13(4)：306-308.
[48]纪向虹,戚红.不同分娩方式对HBV母婴传播的影响[J].山东医药,2002,42(15)：18—19.
[49]Wang J,Zhu Q,Zhang X.Effect of delivery mode on maternal-infant transmission of hepatitis
B virus by immunoprophylaxis[J]. Chin Med J,2002,115(10):1510-1512.
[50]曹鲁泉,田丹,陶靖,等.452例乙型肝炎病毒血清学标志物阳性孕妇母乳乙型肝炎病毒DNA分析[J].中国优生与遗传杂志,2006,14(3)：86-87.
[51].王富兰,张建华.乙型肝炎病毒携带产妇的母乳喂养现状及对策[J].重庆医科大学报,2003,28(2)：254-256.
[48]Hill JB,heffield JS,im MJ,t al.Risk of Hepatitis B Transmission in Breast-ed Infants of Chronic Hepatitis B Carriers[J].Obstet Gynecol,2002,99(8):11049-1052.
[52]王富珍,郑微,陈园生.接种重组乙型肝炎疫苗(酵母)阻断乙型肝炎病毒母婴传播的影响因素分析[J]. CHINESE JOURNAL OF VACCINES AND IMMUNIZATION,2007, 13(4):298-302.
[53]Petrova M,Kamburov V. Breastfeeding and chronic HBV infection; Clinical and social implications[J]. World J Gastroenterol,2010,16(40):5042-5046.
[54]VAN NUNEN AB,DE MAN RA, HEIJ TIN K RA, etal. Lamivudine in the last 4 weeks of pregnancy to prevent perinatal t ransmission in highly viremic chronichepatitis B patient s[J] J Hepatol,2000,32:1040-1041.
[55]项桂菊,孙健伟,江水清,等.拉米夫定联合主动被动免疫干预乙型肝炎病毒母婴垂直传播的疗效评价[J].中国实用医药杂志,2007,2(13)：14-16.
[56]SYED N K,SALAM MW,LUQMAN A K,ct al. Vertical transmission of hepatitis B virus despite maternal lami-vudine therapy[J]. Res letters,2002,359:1488-1489.
[57]http://www.chinacdc.cn/mtdx/crbxx/201204/t20120409_59628.htm
[58]朱启镕,王建设.宫内感染乙型肝炎病毒免疫耐受机制及HBV母婴传播阻断的综合研究[J].医学研究通讯,2003,32(4)：27-28.
[59]孟金来,岳亚飞.HBV母婴传播致新生儿免疫接种失败的原因[J].届外医学：妇幼保健分册,2001,12(2)：73-76.
[60]王珊珊,姜普林,彭桂福,等.垂直传播中乙型肝炎病毒S区变异株检出及其流行病学意义 [J].中华流行病学杂志,1999,20：204-207.
[61]Hamdani-Belghiti S, Bouazzaou NL. Mother-child transmission of hepatitis B Virus. State of the problem and prevention[J].Arch Pediatr,2000,7:879-882.
[62]Hsu H Y, Chang MH, HoHN, et al. Association of HLA. DR14-DR52 with low responsitiveness to hepatitis B Vaccine in Chinese residents in Taiwan[J].Vaccine,1993,11 (40) 1437-1440.
[63]del Canho R,Grosheide P M,Schalm S W,et al. Failure of neonatal hepatitis B vacillation:The role of HBV-DNA levels in hepatitis B carrier mothers and HLA antigens in neonates[J].J Hepatol,1994,20(4):483-486.
[64]孟金来,岳亚飞,张树林.子宫内乙型肝炎病毒感染对新生儿免疫接种的影响[J].中华妇产科杂志,2002,37：136-138.
[2]Kew MC.Geographical Symposium on Viral Hepatitis and Liver Disease Proceeding Books [M].2004:216-221.
[3]Goldstein ST et al. A mathematical model to estimate global hepatitis B disease burden and vaccination impact [J]. International Journal of Epidemiology,2005,34:1329-1339.
[4]Beasley RP et al. Prevention of perinatally transmitted hepatitis B virus infections with hepatitis B immuneglobulin and hepatitis B vaccine [J]. Lancet,1983,2:1099-1102.
[5]Wong VC et al. Prevention of the HBsAg carrier state in newborn infants of mothers who are chronic carriers of HBsAg and HBeAg by administration of hepatitis-B vaccine and hepatitis-B immunoglobulin. Double-blind randomised placebo-controlled study [J]. Lancet, 1984,1:921-926.
[6]de la Hoz F et al. Eight years of hepatitis B vaccination in Colombia with a recombinant vaccine:factors influencing hepatitis B virus infection and effectiveness [J]. International Journal of Infectious Diseases,2008,12:183-189.
[7]Goldstein ST at al. Incidence and risk factors for acute hepatitis B in the United States, 1982-1998:implications for vaccination programs [J]. Journal of Infectious Diseases, 2002,185:713-719.
[8]乐杰,谢辛,林仲秋,等.妇产科学[M]第7版.北京：人民卫生出版,2008：145-149.
[9]张先艳,张小娟,薛艳霞.乙肝病毒母婴垂直传播的阻断措施[J].延安大学学报(医学科学版),2005,3(2)：31.
[10]贾继东.孕妇注射乙型肝炎免疫球蛋白预防乙型肝炎病毒母婴传播的有关问题[J].中华内
科杂志,2007,46(5)：360-361.
[11]Margolis HS et al. Prevention of hepatitis B virus transmission by immunization. An economic analysis of current recommendations [J]. Journal of the American Medical Association,1995,274:1201-1208.
[12]祁国明.中国病毒性肝炎血清流行病学调查[M].北京：科学技术文献,1997：39-60.
[13]陈园生,梁晓峰,陈丽娟,等.中国儿童乙型肝炎疫苗预防接种效果分析[J].中国计划免 疫,2006,12(2)：85-86.
[14]Liang X, Bi S, Yang W, et al. Epidemiological serosurvey of hepatitis B in China--declining HBV prevalence due to hepatitis B vaccination [J]. Vaccine,2009,27(47):6550-7.
[15]Liang X, Bi S, Yang W, et al. Evaluation of the impact of hepatitis B vaccination among children born during 1992-2005 in China. J Infect Dis,2009,200(1):39-47.
[16]朱科伦,朱郇悯,曾文铤.乙型肝炎流行病学的研究新进展[J].广州医药,2010,41(4)：1-2.
[17]Lu FM, Zhuang H. Management of hepatitis B in China [J]. Chin Med J (Engl), 2009,122(1):3-4.
[18]朱启镕.乙型肝炎病毒的母婴传播与阻断研究[J].上海预防医学杂志,2005,17(9)：419.
[19]许红梅,刘作义.乙型肝炎病毒母婴传播及其阻断[J].实用儿科临床杂志,2005,20(9)：835.
[20]骆抗先.乙型肝炎基础与临床[M].北京：人民卫生出版社,1997：233.
[21]谢新宝.乙型肝炎病毒母婴传播和预防研究进展[J].国外医学儿科分册2004,31(5)：225.
[22]Hyams KC.Risks of chronicity following acute hepatitis B virus infection:a review [J]. Clinical Infectious Diseases,1995,20:992-1000.
[23]徐道振,巫善明,周霞秋,等.病毒性肝炎临床实践[M].北京：人民卫生出版社,2006：21.
[24]陈凡金,盛振东,张贻庆HBIG阻断乙肝母婴传播对乙肝疫苗免疫成功率的影响[J].中国热带医学,2010,10,(2)：171-172.
[25]Hieu NT,K.im KH,Janowicz z,et al.Comparative efficacy,safety and imunogenicity of Hepavax-Gene and Engerix-B,recombinant hepatitis B Vaccines,in infants bRRn to HBsAg and HBeAg positive mothers in Vietnam:an assessment at 2 years[J].Vaccine,2002,20:1803.
[26]杨小梅.乙型肝炎病毒母婴传播[J].热带医学杂志,2009,9(9)：1190-1191.
[27]European Association for the Study of the Liver.EASL Clinical Practice Guidelines: Management of chronic hepatitis B[J].J Hepatol,2009,50:227-242.
[28]中华医学会肝病学分会,中华医学会感染病学.慢性乙肝防治指南[M].
[29]王富珍,龚晓红,李辉.北京市乙肝疫苗母婴阻断效果监测分析[J].中国计划免疫,2006,12,97-99.
[30]夏国良,龚健,王继杰,等.重组乙型肝炎疫苗阻断乙型肝炎病毒母婴传播方案的保护效果[J].中华流行病学杂志,2003,24(5)：362-364.
[31]Lok AS, McMahon BJ. AASLD practice guidelines. Chronic hepatitis B:update 2009. Hepatology,2009,50:1-36.
[32]Shi Z,Li X,Ma L,et al.Hepatitis B immunoglobulin injection in pregnancy to interrupt hepatitis B virus mother -to-child transmission -a meta -analysis[J].Int J Infect Dis,2010,14(7): 622-634.
[33]董悦.《慢性乙型肝炎防治指南》中阻断母婴传播的相关内容[J].中华围产医学杂志,2006,9(5)：360.
[34]朱云霞,邹怀宾,等.不同分娩方式对阻断乙型肝炎病毒母婴传播的影响[J].山西医科大学学报(J Shanx iM ed Univ),2010,41(6):495-496.
[35]李继军,王富珍,郑徽,等.不同分娩方式对乙型肝炎病毒母婴传播的影响[J].中国计划免疫,2007,13(4)：306-308.
[36]纪向虹,戚红.不同分娩方式对HBV母婴传播的影响[J].山东医药,2002,42(15)：18-19.
[37]Wang J,Zhu Q,Zhang X.Effect of delivery mode on maternal-infant transmission of hepatitis B virus by immunoprophylaxis[J]. Chin Med J,2002,115(10):1510-1512.
[38]Xu DZ,Yan YP.Choi BC,et a 1.Risk factors and mechanism of transplacental
transmission of hepatitis B virus:a case-control study [J].J Med Virol,2002,67:20-6.
[39]曹鲁泉,田丹,陶靖,等.452例乙型肝炎病毒血清学标志物阳性孕妇母乳乙型肝炎病毒DNA分析[J].中国优生与遗传杂志,2006,14(3)：86-87.
[40]王富兰,张建华.乙型肝炎病毒携带产妇的母乳喂养现状及对策[J].重庆医科大学报,2003,28(2)：254-256.
[41]Petrova M,Kamburov V.Breastfeeding and chronic HBV infection: Clinical and social implications[J].World J Gastroenterol,2010,16(40):5042-5046.
[42]崔富强,王富珍,郑徽,等.接种不同剂量重组乙型肝炎疫苗(酵母)阻断乙型肝炎病毒母婴传播的评价[J].中国计划免疫,2007,13(4)：289-292.
[43]WHO.Hepatitis B Vaccines[J].WER,2004,28(79):255-263.
[44]卫生部政策法规司卫生政务通报第15期(2005年6月16日).
[45]YAN Kai-hua, LI Li-li, CHEN Shu-ying,et al. Assessment of effect of HBIG combined with hepatitis B vaccine in interrupting vertical transmission of HBV from mothers to babies[J].China Tropical Medicine,2009,3:58-60.
[46]王富珍,崔富强,郑徽等.重组乙型肝炎疫苗(酵母)与乙型肝炎免疫球蛋白联合免疫阻断乙型肝炎病毒母婴传播的效果分析[J].中国计划免疫,2007,13(4)：293-297.
[47]Xu WM,Cui YT,Wang L,et al.Lamivudine in late pregnancy to prevent perinatal transmission of hepatitis B virus infection:a multicentre,randomized,double-blind,placebo -controlled study[J].J Viral Hepat,2009,16(2):94-103.
[48]孙莲英,庞志钊,张文英,等.不同剂量重组乙型肝炎疫苗(酵母)阻断乙型肝炎病毒母婴传播的研究[J].中国计划免疫,2006,12(4)：262-263.
[49]李强,赵月.重组酵母乙肝疫苗与乙肝免疫球蛋白联合对乙肝母婴传播阻断效果观察[J].中国社区医师,2011,163(277)：117.
[50]Hammitt LL et al. Hepatitis B immunity in children vaccinated with recombinant hepatitis B vaccine beginning at birth: a follow-up study at 15 years. Vaccine,2007,25:6958-6964.
[51]彭文伟,传染病学[M]第4版.z北京：人民卫生出版社,2004：40-41.
[52]袁国平,李明珠,于科.乙肝疫苗联合免疫球蛋白阻断母婴传播效果[J].中国公共卫生2009,25(12)：1479-1480.
[53]Wiseman E, Fraser MA, Holden S, et al Perinatal transmission of hepatitis B virus:an Australian experience [J].Med J Aust,2009,190(9):489-92.
[54]冯永亮,王素萍,魏俊妮等.乙型肝炎病毒宫内感染危险因素研究[J].中华流行病学杂志,2008,29(2)：132-135.
[55]李克勇,刘沛.乙型肝炎疫苗和乙型肝炎免疫球蛋白联合应用阻断乙型肝炎病毒母婴传播的分析[J].东南大学学报(医学版),2007,26(1)：43-44.
[56]宋婷婷,单芙香,程锦泉,等.乙肝疫苗和免疫球蛋白阻断乙肝母婴传播效果研究[J].中华疾病控制杂志,2011,15(6)：497-499.
[57]岳亚飞,杨晓菊,张树林,等.乙肝表面抗原阳性孕妇肌注乙肝免疫球蛋白预防母婴传播的临床研究[J].中国实用妇科与产科杂志,1999,15(5)：547-549.
[58]王建设,朱启镕,张秀珍.分娩方式对乙型肝炎病毒母婴传播阻断效果的影响.中华医学杂志,2001,81：108.
[59]陈红,任杰,刘晓红.不同分娩方式对乙型肝炎病毒母婴传播的影响.中国妇幼健康研究,2008,19：214-216.
[60]张绍芳,刘杰波,张爱香.分娩与阻断方式对HBV母婴垂直传播的影响[J].现代预防医学,2005,32(8)：933.
[61]曹鲁泉,田丹,陶靖,等.452例乙型肝炎病毒血清学标志物阳性孕妇母乳乙型肝炎病毒DNA分析[J].中国优生与遗传杂志,2006,14(3)：86-87.
[62]王谢桐,于恩燕.妊妊娠合并乙型病毒性肝炎的母婴传播与阻断[J].实用妇产科杂志,2010, 26(4)：244-246.
[63]段恕诚,朱启,吕晴,等.乙肝疫苗对宫内感染的初步研究..临床儿科杂志,1993,18(11)：1492-1500.
[1]Ganem D,Prince AM. Hepatitis B virus infection-natural history and clinical consequences [J]. N Eng l J Med,2004,350(11):1118-29.
[2]Kew MC.Geographical Symposium on Viral Hepatitis and Liver Disease Proceeding Books [M].2004:216-221.
[3]Goldstein ST et al. A mathematical model to estimate global hepatitis B disease burden and vaccination impact [J]. International Journal of Epiderniology,2005,34:1329-1339.
[4]Beasley RP et al. Prevention of perinatally transmitted hepatitis B virus infections with hepatitis B immuneglobulin and hepatitis B vaccine [J]. Lancet,1983,2:1099-1102.
[5]Wong VC et al. Prevention of the HBsAg carrier state in newborn infants of mothers who are chronic carriers of HBsAg and HBeAg by administration of hepatitis-B vaccine and hepatitis-B immunoglobulin. Double-blind randomised placebo-controlled study [J]. Lancet, 1984,1:921-926.
[6]de la Hoz F et al. Eight years of hepatitis B vaccination in Colombia with a recombinant vaccine: factors influencing hepatitis B virus infection and effectiveness [J]. International Journal of Infectious Diseases,2008,12:183-189.
[7]Goldstein ST at al. Incidence and risk factors for acute hepatitis B in the United States, 1982-1998:implications for vaccination programs [J]. Journal of Infectious Diseases, 2002,185:713-719.
[8]乐杰,谢辛,林仲秋,等.妇产科学[M]第7版.北京：人民卫生出版,2008：145-149.
[9]张先艳,张小娟,薛艳霞.乙肝病毒母婴垂直传播的阻断措施[J].延安大学学报(医学科学版),2005,3(2)：31.
[10]贾继东.孕妇注射乙型肝炎免疫球蛋白预防乙型肝炎病毒母婴传播的有关问题[J].中华内科杂志,2007,46(5)：360-361.
[11]Margolis HS et al. Prevention of hepatitis B virus transmission by immunization. An economic analysis of current recommendations [J]. Journal of the American Medical Association,1995,274:1201-1208.
[12]祁国明.中国病毒性肝炎血清流行病学调查[M].北京：科学技术文献,1997：39-60.
[13]陈园生,梁晓峰,陈丽娟,等.中国儿童乙型肝炎疫苗预防接种效果分析[J].中国计划免 疫,2006,12(2)：85-86.
[14]Liang X, Bi S, Yang W, et al. Epidemiological serosurvey of hepatitis B in China--declining
HBV prevalence due to hepatitis B vaccination [J]. Vaccine,2009,27(47):6550-7.
[15]Liang X, Bi S, Yang W, et al. Evaluation of the impact of hepatitis B vaccination among
children born during 1992-2005 in China. J Infect Dis,2009,200(1):39-47.
[16]朱科伦,朱郇悯,曾文铤.乙型肝炎流行病学的研究新进展[J].广州医药,2010,41(4)：1-2.
[17]Lu FM, Zhuang H. Management of hepatitis B in China [J]. Chin Med J (Engl), 2009,122(1):3-4.
[18]朱启镕.乙型肝炎病毒的母婴传播与阻断研究[J].上海预防医学杂志,2005,17(9)：4]9.
[19]许红梅,刘作义.乙型肝炎病毒母婴传播及其阻断[J].实用儿科临床杂志,2005,20(9)：835.[20]骆抗先.乙型肝炎基础与临床[M].北京：人民卫生出版社,1997：233.
[21]谢新宝.乙型肝炎病毒母婴传播和预防研究进展[J].国外医学儿科分册,2004,31(5)：225.
[22]Hyams KC.Risks of chronicity following acute hepatitis B virus infection:a review [J]. Clinical Infectious Diseases,1995,20:992-1000.
[23]徐道振,巫善明,周霞秋,等.病毒性肝炎临床实践[M].北京：人民卫生出版社,2006：21.
[24]陈凡金,盛振东,张贻庆HB1G阻断乙肝母婴传播对乙肝疫苗免疫成功率的影响[J].中国热带医学,2010,10,(2)：171-172.
[25]Hieu NT,Kim KH,Janowicz z,et a 1.Comparative efficacy,safety and imunogenicity of Hepavax-Gene and Engerix-B,recombinant hepatitis B Vaccines,in infants bRRn to HBsAg and HBeAg positive mothers in Vietnam:an assessment at 2 years[J].Vaccine,2002,20:1803.
[26]XU DZ,YAN YP.CHOI BC,et al. Risk factors and mechanism of transplacental transmission of hepatitis B virus:a case2cont rol study[J]. J Mcd Virol,2002,67 (20):226.
[27]Ohto H,Lin H, Kaw ana T,et al. Intrauterine transmission of hepatitis B virus is closely related to placcntal leakage[J]. Journal ofth e M edical Virology,1987,21(1):1-6.
[28]闫永平,徐德忠,徐剑秋,等.乙型肝炎病毒宫内传播机制的分子流行病学研究[J].中华流行病学杂志,1998,19(3)：131-133.
[29]朱云霞,邹怀宾,等.不同分娩方式对阻断乙型肝炎病毒母婴传播的影响[J].山西医科大学学报(J Shanx iMed Univ),2010,41(6):495-496.
[30]郦爱贞,肖小敏.乙肝病毒宫内感染临床诊断标准的探讨[J].中国妇幼保健,2007,22(4)：475-477.
[31]Wang J,Sun L. Study on the cellular molecular mechanism of intrauterine transmission of HBV [J]. Journal of Najing Medical University,2003,17,17(5):243.
[32]马力,赵桂珍,曲以琴,等.乙肝病毒携带母亲乳汁中HBsAg/HBeAg与HBV DNA检测结果相关性的探讨[J].中国医科大学学报,1997,26(6)：645-6.
[33]李健,倪季军,乙型肝炎病毒母婴传问题探讨[J].厦门大学学报：自然科学版,2000,39(6)：869-872.
[34]岳瑛,何净,乐杰,等.乙型肝炎病毒血清学标志物阳性的产妇乳汁母婴传播的研究[J].中国妇幼保健,1997,12(3)：166-167.
[35]张兰英,付金凤,李晓平,等.HBV携带者首次初乳和24小时后母乳HBV-DNA携带情况比较[J].中国妇幼保健,1999,14(7)：445-446.
[36]李顿华,姚琪纬,陈颖,等.联合免疫后HBV携带者母乳喂养的安全性研究[J].第七届全国小儿肝病学术会议论文集,2003：20.
[37]彭文伟.病毒性肝炎研究[M].广东科技出版社,1998：25.
[38]沈菁,潘敏,杨丽娟,等.乙肝血清学阳性产妇乳汁中乙肝病毒检测及母婴传播的研究[J].广西医科大学学报,2005,22(1)：76.
[39]林静吟,许岸高,袁建寰,等.乙肝病毒母婴传播的可能途径研究[J].中国实用妇科和产科杂志,1999,15：424-426.
[40]石理兰,张琳,赵桂珍.妊娠合并乙肝病毒感染的流行病学研究进展中国实用妇科与产科杂志[J].2004,20(2)：119-121.
[41]封秀红,王春俭,刁琳琪,等.乙肝疫苗阻断乙肝围产期传播的长期效果研究,1999,15(8)：694.
[42]龚晓红,刘立荣,裴红生,等.北京地区HBsAg口性母亲的儿童乙型肝炎疫苗免疫后血清学监测结果分析[J].中国计划免疫,2000,6(6)：366-368.
[43]卫生部.2004全年计划免疫综合审评报告[M].北京：人民卫生出版社,2005：17.
[44]Shi Z,Li X,Ma L,et al. Hepatitis B immunoglobulin injection in pregnancy to interrupt hepatitis B virus mother -to -child transmission -a meta -analysis[J].Int J Infect Dis,2010,14(7): e622-634.
[45]岳亚飞,杨晓菊,张树林,等.乙肝表面抗原阳性孕妇肌注乙肝免疫球蛋白预防母婴传播的临床研究[J].中国实用妇科与产科杂志,1999,15(9)：547-549.
[46]董悦.《慢性乙型肝炎防治指南》中阻断母婴传播的相关内容[J].中华围产医学杂 志,2006,9(5)：360.
[47]李继军,王富珍,郑徽,等.不同分娩方式对乙型肝炎病毒母婴传播的影响[J].中国计划免疫,2007,13(4)：306-308.
[48]纪向虹,戚红.不同分娩方式对HBV母婴传播的影响[J].山东医药,2002,42(15)：18—19.
[49]Wang J,Zhu Q,Zhang X.Effect of delivery mode on maternal-infant transmission of hepatitis
B virus by immunoprophylaxis[J]. Chin Med J,2002,115(10):1510-1512.
[50]曹鲁泉,田丹,陶靖,等.452例乙型肝炎病毒血清学标志物阳性孕妇母乳乙型肝炎病毒DNA分析[J].中国优生与遗传杂志,2006,14(3)：86-87.
[51].王富兰,张建华.乙型肝炎病毒携带产妇的母乳喂养现状及对策[J].重庆医科大学报,2003,28(2)：254-256.
[48]Hill JB,heffield JS,im MJ,t al.Risk of Hepatitis B Transmission in Breast-ed Infants of Chronic Hepatitis B Carriers[J].Obstet Gynecol,2002,99(8):11049-1052.
[52]王富珍,郑微,陈园生.接种重组乙型肝炎疫苗(酵母)阻断乙型肝炎病毒母婴传播的影响因素分析[J]. CHINESE JOURNAL OF VACCINES AND IMMUNIZATION,2007, 13(4):298-302.
[53]Petrova M,Kamburov V. Breastfeeding and chronic HBV infection; Clinical and social implications[J]. World J Gastroenterol,2010,16(40):5042-5046.
[54]VAN NUNEN AB,DE MAN RA, HEIJ TIN K RA, etal. Lamivudine in the last 4 weeks of pregnancy to prevent perinatal t ransmission in highly viremic chronichepatitis B patient s[J] J Hepatol,2000,32:1040-1041.
[55]项桂菊,孙健伟,江水清,等.拉米夫定联合主动被动免疫干预乙型肝炎病毒母婴垂直传播的疗效评价[J].中国实用医药杂志,2007,2(13)：14-16.
[56]SYED N K,SALAM MW,LUQMAN A K,ct al. Vertical transmission of hepatitis B virus despite maternal lami-vudine therapy[J]. Res letters,2002,359:1488-1489.
[57]http://www.chinacdc.cn/mtdx/crbxx/201204/t20120409_59628.htm
[58]朱启镕,王建设.宫内感染乙型肝炎病毒免疫耐受机制及HBV母婴传播阻断的综合研究[J].医学研究通讯,2003,32(4)：27-28.
[59]孟金来,岳亚飞.HBV母婴传播致新生儿免疫接种失败的原因[J].届外医学：妇幼保健分册,2001,12(2)：73-76.
[60]王珊珊,姜普林,彭桂福,等.垂直传播中乙型肝炎病毒S区变异株检出及其流行病学意义 [J].中华流行病学杂志,1999,20：204-207.
[61]Hamdani-Belghiti S, Bouazzaou NL. Mother-child transmission of hepatitis B Virus. State of the problem and prevention[J].Arch Pediatr,2000,7:879-882.
[62]Hsu H Y, Chang MH, HoHN, et al. Association of HLA. DR14-DR52 with low responsitiveness to hepatitis B Vaccine in Chinese residents in Taiwan[J].Vaccine,1993,11 (40) 1437-1440.
[63]del Canho R,Grosheide P M,Schalm S W,et al. Failure of neonatal hepatitis B vacillation:The role of HBV-DNA levels in hepatitis B carrier mothers and HLA antigens in neonates[J].J Hepatol,1994,20(4):483-486.
[64]孟金来,岳亚飞,张树林.子宫内乙型肝炎病毒感染对新生儿免疫接种的影响[J].中华妇产科杂志,2002,37：136-138.