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目的探析乙型肝炎免疫球蛋白(HBIG)联合乙型肝炎疫苗阻断母婴垂直传播乙型肝炎病毒(HBV)的阻断效果及临床疗效。方法分析乙肝表面抗原(HBs Ag)呈阳性的250例孕妇的临床资料。将入选者分成母乳喂养组和人工喂养组。比较两组新生儿的宫内感染率与免疫阻断效果、出生及1、3年后的乙肝病毒表面抗体(HBs Ab)阳性率及不良反应发生率。结果母乳喂养组与人工喂养组新生儿HBV宫内感染率及1年后的HBV感染率无统计学差异(P>0.05);而母乳喂养组及人工喂养组内新生儿HBV宫内感染率及1年后的HBV感染率有统计学差异(χ~2=5.750,P=0.016;χ~2=6.670,P=0.010)。产妇HBs Ag单阳性与HBs Ag和HBe Ag双阳性两组新生儿的宫内感染率及1年后HBV感染率比较有统计学差异(χ~2=12.390,P=0.000;χ~2=8.126,P=0.004)。母乳喂养组与人工喂养组新生儿出生与联合免疫后1岁HBs Ab阳性率均无统计学差异;而母乳喂养组内新生儿出生与联合免疫后1岁HBs Ab阳性率有统计学差异(χ~2=134.640,P=0.000);人工喂养组内新生儿出生与联合免疫后1岁HBs Ab阳性率有统计学差异(χ~2=140.500,P=0.000)。产妇HBs Ag单阳性与HBs Ag及HBe Ag双阳性3年后幼儿的HBV感染率存在统计学差异(χ~2=11.930,P=0.001),两组接种疫苗后的不良反应发生率无统计学差异(χ~2=0.256,P=0.610)。结论 HBIG+乙肝疫苗的联合应用对新生儿HBV感染具有良好的阻断疗效。HBV感染率与宫内感染有关,与孕妇HBs Ag和HBe Ag是否双阳性有关,与新生儿的出生方式及喂养方式无关,因此HBs Ag+产妇新生儿采用正规联合免疫后可正常母乳喂养,母乳喂养并不会增加HBV感染率。
Objective To investigate the blocking effect and clinical effect of hepatitis B immunoglobulin (HBIG) combined with hepatitis B vaccine in blocking the vertical transmission of hepatitis B virus (HBV) in the mother and infant. Methods The clinical data of 250 pregnant women with positive HBsAg were analyzed. The candidates were divided into breastfeeding group and artificial feeding group. The intrauterine infection rate and immune blockade effect of newborns in both groups were compared. The positive rates of HBs Ab and the incidence of adverse reactions after birth and one and three years after birth were compared. Results There was no significant difference in the intrauterine infection rate of newborns between the breastfeeding group and the artificial feeding group and the HBV infection rate after one year (P> 0.05), while the intrauterine infection rate of the newborns in the breastfeeding group and the artificial feeding group The HBV infection rate after 1 year was statistically different (χ ~ 2 = 5.750, P = 0.016; χ ~ 2 = 6.670, P = 0.010). The intrauterine infection rates of HBsAg single mothers and HBs Ag HBeAg double positive mothers and the HBV infection rates after one year were statistically different (χ ~ 2 = 12.390, P = 0.000; χ ~ 2 = 8.126 , P = 0.004). There was no significant difference in the positive rates of HBs Ab between 1-year-old and newborns in breastfeeding group and artificial feeding group, while the positive rates of HBs Ab in 1-year-old and newborns breast-feeding group were statistically different (χ ~ 2 = 134.640, P = 0.000). There was a significant difference in the positive rate of HBs Ab between the newborn born and the co-immunized one year old group (χ ~ 2 = 140.500, P = 0.000) There was a significant difference in the HBV infection rates of the mothers between HBsAg single positive and HBs Ag and HBeAg three years later (χ ~ 2 = 11.930, P = 0.001). There was no statistical difference in the incidence of adverse reactions after vaccination between the two groups Difference (χ ~ 2 = 0.256, P = 0.610). Conclusion The combined use of HBIG + hepatitis B vaccine has a good blocking effect on neonatal HBV infection. HBV infection rate and intrauterine infection, and pregnant women HBsAg and HBeAg whether double-positive, and newborn birth patterns and feeding methods has nothing to do, so HBsAg + newborns with normal combined immunization can be normal breastfeeding, breastfeeding Does not increase the rate of HBV infection.