HBV孕妇注射乙肝免疫球蛋白阻断HBV母婴垂直传播的免疫机制

发布时间：2018-09-17 17:41

【摘要】：目的:探讨母体注射乙肝免疫球蛋白(HBIG)阻断HBV母婴垂直传播的被动免疫效果和机制。方法:选取本院收治的慢性乙型病毒性肝炎孕产妇94例,随机分为对照组31例,婴儿干预组31例,和母婴共干预组32例;对照组不给予HBIG干预,婴儿干预组在婴儿出生6 h之内给予HBIG干预,母婴共干预组分别在母体孕28、32、36周和婴儿出生6 h之内给予HBIG干预;此外,三组新生儿均在出生后0、1、6月接种乙肝疫苗,并于末次接种后取患儿空腹外周血,进行乙肝标记物、HBV-DNA及免疫功能检测。结果:三组新生儿HBe Ag、HBs Ag、HBV-DNA阳性率有显著性差异(P0.05),以对照组为最高,母婴共干预组最低;HBe Ab阳性率亦有显著性差异(P0.05),以对照组为最低,母婴共干预组最高。三组新生儿的补体C3、C4水平及T淋巴细胞亚型CD3+T、CD4+T、CD8+T计数均有显著性差异(P0.05),以对照组为最低,母婴共干预组最高;在免疫球蛋白方面,婴儿干预组和母婴共干预组的Ig G、Ig M显著高于对照组(P0.05),而Ig A无明显组间差异(P0.05)。结论:母体HBIG注射可有效激活母体的体液免疫和细胞免疫,降低母体中病毒含量。此外,通过胎盘对胎儿的影响,协同使新生儿产生抗原-抗体反应,缓解HBV病毒所诱发的T淋巴细胞耗损,有可能发挥其对HBV母婴垂直传播的阻断作用。
[Abstract]:Aim: to investigate the passive immune effect and mechanism of maternal injection of hepatitis B immunoglobulin (HBIG) to block vertical transmission of HBV from mother to child. Methods: 94 pregnant women with chronic viral hepatitis B were randomly divided into control group (n = 31), infant intervention group (n = 31) and mother and infant intervention group (n = 32). The infant intervention group received HBIG intervention within 6 hours of birth, while the mother and infant intervention group received HBIG intervention within 2832 weeks of gestation and within 6 hours of birth respectively, in addition, all three groups of newborns were vaccinated with hepatitis B vaccine within 1 month after birth. After the last inoculation, the fasting peripheral blood was taken to detect HBV DNA and immune function. Results: there was significant difference in the positive rate of HBe Ag,HBs Ag,HBV-DNA among the three groups (P0.05), the highest in the control group, and the lowest in the mother and infant intervention group (P0.05), the lowest in the control group and the highest in the mother and infant co-intervention group. There were significant differences in the levels of complement C _ 3 C _ 4 and T lymphocyte subtype CD3 T _ 4 / CD _ 8 T _ 8 in the three groups (P0.05), the lowest in the control group, the highest in the mother and infant intervention group, and the highest in the immunoglobulin group. The levels of Ig G G M in the infant intervention group and the mother and infant co-intervention group were significantly higher than those in the control group (P0.05), but there was no significant difference between the two groups in Ig A (P0.05). Conclusion: maternal HBIG injection can effectively activate the humoral and cellular immunity of the mother and decrease the virus content in the mother. In addition, the effect of placenta on fetus could induce antigen-antibody reaction in neonates and alleviate the depletion of T lymphocytes induced by HBV virus, which might play a role in blocking the vertical transmission of HBV from mother to child.
【作者单位】：海南省人民医院药学部;海南省人民医院中心实验室;
【分类号】：R714.251

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