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目的探讨孕妇乙型肝炎病毒(HBV)抗原抗体定量测定在阻断乙型肝炎病毒宫内传播中的意义。方法我院分娩的乙肝表面抗原(HBsAg)阳性、乙肝核心抗体(HbcAb)阳性、乙肝e抗原(HBeAg)阴性孕产妇445例及其分娩的新生儿445例作为观察对象。其中孕产妇乙肝e抗体(HBeAb)阳性349例(作为干预1、2组和对照1组),HBeAb阴性96例(作为对照2组)。⑴干预1组:孕妇孕28、32、36周共3次肌肉注射乙肝免疫球蛋白(HBIG)200IU,共133例。⑵干预2组:孕妇孕20～27周检测静脉血HBsAg、HBeAb和HBcAb定量,HBeAb定量大于50ncu/ml者孕28、32、36周分别肌肉注射HBIG400IU,共124例。⑶对照1组:孕期未注射HBIG,共92例。⑷对照2组:孕期未注射HBIG,共96例。检测各组孕妇的新生儿生后12h内静脉血HBV抗原定性。结果干预2组孕妇46例(37.1%)HbsAg升高、41例(33.1%)HbcAb升高;新生儿HBV定性,干预1组阳性2例(1.5%),对照1组阳性4例(4.3%),两组之间阳性率对比(χ2=1.695,P=0.193)差异无统计学意义,干预2组和对照2组无HBV定性阳性。结论孕妇HBsAg和HBcAb定量值高者未见宫内传播者。孕妇HBeAb定量值低者未见宫内传播者。HBeAb定量值高的孕妇分娩HBV定性阳性新生儿的可能性大,故可作为HBIG阻断宫内传播对象的参考。HBeAb定量增高与宫内传播关系的探讨目前是初步的,尚待继续深入研究。
Objective To explore the significance of quantitative determination of hepatitis B virus (HBV) antigen antibody in pregnant women for blocking intrauterine transmission of hepatitis B virus. Methods HBsAg positive, HBcAb positive, 445 HBeAg negative pregnant women and 445 neonates delivered during delivery in our hospital were observed. Among them, 349 were positive for HBeAb (as group 1, 2 and control 1) and 96 were negative for HBeAb (group 2 as control). Intervention group 1: Pregnant women pregnant 28, 32, 36 weeks, a total of 3 intramuscular injection of hepatitis B immunoglobulin (HBIG) 200IU, a total of 133 cases. Intervention group 2: pregnant women 20 to 27 weeks of pregnancy to detect venous blood HBsAg, HBeAb and HBcAb quantitative, HBeAb quantitative greater than 50ncu / ml pregnant 28,32,36 weeks were intramuscularly injected HBIG400IU, a total of 124 cases. ⑶ control group 1: HBIG not injected during pregnancy, a total of 92 cases. ⑷ control group 2: HBIG not injected during pregnancy, a total of 96 cases. Venous blood HBV antigens were detected within 12 hours after birth in each group of pregnant women. Results HbsAg was elevated in 46 (37.1%) pregnant women and 41 (33.1%) HbcAb in intervention group. Serum levels of HbcAb in neonates were higher than those in control group 1 ). There was no significant difference in the positive rate between the two groups (χ2 = 1.695, P = 0.193). The two groups and the control group 2 had no positive qualitative HBV. Conclusion There was no intrauterine transmission of HBsAg and HBcAb in pregnant women. Pregnant women with low quantitative HBeAb no intrauterine transmission. HBeAb pregnant women with high quantitative value of delivery of qualitative positive neonatal chance of HBV, it can be used as a reference for intrauterine transmission of HBIG block object. The relationship between quantitative HBeAb and intrauterine transmission is still preliminary and remains to be further studied.