A Study of Reducing the Transmission of HBV from Mother to Infant in HBeAg Positive Pregnant Women_Chinese Journal of Evidence-Based Medicine

Authors：

XU Qin ¹ , XIAO Lin ² , CAI Xia ² , ZHANG Yuexin ² , LI Fang ² , XU Linshan ³ , GAN Wei ⁴ , XIA Yu ⁵ , ZHANG Xinmei ² , WANG Lan ⁶ , YANG Ling ⁷ , QIAO Min ⁸ , GU Li ² , WANG Xiaolan ² , ZHOU Kang ¹ , CHEN Xueling ¹ , LU Xiaobo ² , XU Hang ²

Corresponding author：

Keywords：

Hepatitis B; HBeAg; Mother-infant transmissibility; Hepatitis B immune globulin; Randomized controlled trial

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Objective 　To explore the effectiveness of passive immunization of fetus via mother on preventing the transmission of HBV from mother to infant.
Methods 　A prospective randomized controlled study was designed. Fifty-two HBeAg positive pregnant women were randomly allocated to two groups, of which 28 women were allocated to trial group, and injected with 200 IU of hepatitis B immune globulin (HBIG) for 1 injection at the 28th, 32nd and 36th weeks of pregnancy respectively, 24 women allocated to control group were given no injection of HBIG. The samples of cord blood from the newborns in two groups were collected and tested for HBeAg and HBV-DNA by ELISA and FQ-PCR.
Results 　The rates of HBeAg positive in the newborns were 21.4% in trial group, 79.2% in control group. There was statistically significant difference between two groups ( χ2=17.26, P lt;0.01, RR=0.27). The rates of HBV-DNA positive in newborns were 25.0% in trial group, 83.3% in control group, showing statistically significant difference between the two groups (χ2=17.62, P lt;0.01, RR=0.30). In the trial group, there were 21 newborns with HBV-DNA negative, 7 with HBV-DNA positive. HBV-DNA quantities were significantly lower in 7 newborns than in their mothers (T=28, P=0.02, Wilcoxon test).
Conclusions 　Multiple injections of HBIG to pregnant women with HBeAg positive before labor could greatly reduce mother-infant transmission of HBV.

Citation： XU Qin,XIAO Lin,CAI Xia,ZHANG Yuexin,LI Fang,XU Linshan,GAN Wei,XIA Yu,ZHANG Xinmei,WANG Lan,YANG Ling,QIAO Min,GU Li,WANG Xiaolan,ZHOU Kang,CHEN Xueling,LU Xiaobo,XU Hang. A Study of Reducing the Transmission of HBV from Mother to Infant in HBeAg Positive Pregnant Women. Chinese Journal of Evidence-Based Medicine, 2004, 04(5): 306-309. doi: Copy

1.	朱启容,于广军,吕晴,俞蕙,顾新焕,张秀珍,董左权.阻断乙型肝炎病毒宫内传播的随机对照试验[J].中华儿科杂志,2002;40(8):478～480.
2.	［6］Badur S, Lazizi Y, UgurIu M, Perk Y, IIter O, AydinIi K,Pillot J, Transplacental passage of hepatitis B virus DNA from hepatitis B e antigen negative mothers and delayed immune response in newborns [J]. J Infect Dis, 1994; 169(3): 704 -706.
3.	［7］Li XM, Yang YB, Hou HY, Shi ZJ, Shen HM, Teng BQ,Li AM, Shi MF, Zou L. Interruption of HBV intrauterine: a clinical study [J]. Ward J Gastroenterol, 2003; 9(7): 1 501- 1 503.
4.	［8］Towers CV, Asrat T, R umney P. The presence of hepatitis B surface antigen and deoxyribonucleic acid in arnniotic fluid and cord blood [J]. Am J Obstet Gynecol, 2001; 184(7) :1514 - 1 518.
5.	［9］Lin YL, Kuang JQ, Liu XZ, Chen MY. The expression of HBcAg in HBV carrier mother’ placentas and it’ s significance[J]. Acad J SUMS, 2000; 21(1) :43 -46.
6.	刘颖琳,邝健全,刘新质,陈镆铘.HbcAg在乙型肝炎病毒携带者孕妇胎盘中的识别与意义.中山医科大学学报,2000;21(1):43～46.
7.	［10］Yu GJ, Zhu QR. Study on the relationship between IL-2/IL-2R and immunization failure of hepatitis B vaccine in the children with HBV intrauterine infection [J]. Chinese J Infect Dis, 1998; 16(3): 151-153.
8.	于光军,朱启容.HBV宫内感染儿童接种乙型肝炎疫苗免疫失败与IL-2及其受体的关系[J].中华传染病杂志,1998;16(3):151～153.
9.	［11］Ayoola EA, Johnson AO. Hepatitis B vaccine in pregnancy:immunogenic city, safety and transfer of antibodies to infants[J]. Int J Gynaecol Obstet, 1987; 25(4): 297 -301.
10.	［12］Hu GY, Tan WH, Wang GR The observation of effects on immunization with hepatitis B vaccine in the late period of pregnancy [J ]. Journal of Harbin Medical University, 1996;30(1) :72 -73.
11.	胡桂英,谭文华,王桂荣.妊娠后期接种乙肝疫苗免疫效果的观察[J].哈尔滨医科大学学报,1996;30(1):72～73.
12.	［13］Zhang LY, Fang ZX, Zhen ZL, Liu XY, Gong XP, Wu YX. The study of transmission route of HBV fiom father to infant [J]. Chinese J Infect Dis, 1994; 12(4): 199 -201.
13.	张丽云,方之勋,郑兆,刘新钰,龚希平,吴玉祥.父婴传播途径的初步研究[J]中华传染病杂志,1994;12(4): 199 ～201.
14.	［14］Zhao LS, Liu XS, Zhang ZX, Wang JR, Liu L, Lei BJ.Study on HBV vertical transmission via infected spermatozoa[J]. Chinese J Infect Dis, 1998; 16(3): 154 - 157.
15.	赵连三,刘晓松,张智翔,王锦蓉,刘丽,雷秉钧.乙型肝炎病毒感染经精子传播的可能性研究[J].中华传染病杂志,1998;16(3):154～157.
16.	［1］Yue YF, Yang XJ, Zhang SL, Han XB. Clinical study on the prevention of HBV transmission fiom mother to infant by injection of HBIG in pregnant women with HBsAg [J]. Chinese Journal of Practical Gynecology and Obstetrics, 1999; 15(9) :547 -548.
17.	岳亚飞,杨晓菊,张树林,韩晓兵.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):547～548.
18.	［2］Liu HY, Ma YY, Cui BX, Dal MS, Yang J. The study of mechanism about interrupting HBV transmission from mother to infant by HBIG passive immunization in pregnant women[J]. Current Advances in Obstetrics and Gynecology, 2002; 11(2): 128 -130.
19.	［3］Ruff TA, Gertig DM, Otto BF, Gust ID, Sutanto A,Soewarso TI, Kandun N, Marschner IC, Maynard JE. Lombok Hepatitis B Model Immunization Project:toward universal infant hepatitis B immunization in Indonesia [J ]. J Infect Dis,1995; 171(2): 290-296.
20.	［4］Tu SY, Wu Y, Yu DY, Wang Y, Liu QK, Hu GL, Yang WF. The study of interruption of HBV transmission from mother to infant by hepatitis B vaccine [J]. Chinese Journal of Obstetrics and Gynecology, 1991; 26(6): 358-360.
21.	涂世玺,武玉,余大勇,汪燕,刘庆宽,胡广连,杨蔚芬.乙型肝炎疫苗阻断HBV母婴传播的研究[J].中华妇产科杂志,1991;26(6):358～360.
22.	［5］Zhu QR, Yu GJ, Lu Q, Yu H, Gu XH, Zhang XZ, Dong ZQ. A study of Controlled Clinical Trial on interruption of HBV intrauterine transmission [J]. Chinese Journal of Pediatriology, 2002; 40(8): 478-480.

1. 朱启容,于广军,吕晴,俞蕙,顾新焕,张秀珍,董左权.阻断乙型肝炎病毒宫内传播的随机对照试验[J].中华儿科杂志,2002;40(8):478～480.
2. ［6］Badur S, Lazizi Y, UgurIu M, Perk Y, IIter O, AydinIi K,Pillot J, Transplacental passage of hepatitis B virus DNA from hepatitis B e antigen negative mothers and delayed immune response in newborns [J]. J Infect Dis, 1994; 169(3): 704 -706.
3. ［7］Li XM, Yang YB, Hou HY, Shi ZJ, Shen HM, Teng BQ,Li AM, Shi MF, Zou L. Interruption of HBV intrauterine: a clinical study [J]. Ward J Gastroenterol, 2003; 9(7): 1 501- 1 503.
4. ［8］Towers CV, Asrat T, R umney P. The presence of hepatitis B surface antigen and deoxyribonucleic acid in arnniotic fluid and cord blood [J]. Am J Obstet Gynecol, 2001; 184(7) :1514 - 1 518.
5. ［9］Lin YL, Kuang JQ, Liu XZ, Chen MY. The expression of HBcAg in HBV carrier mother’ placentas and it’ s significance[J]. Acad J SUMS, 2000; 21(1) :43 -46.
6. 刘颖琳,邝健全,刘新质,陈镆铘.HbcAg在乙型肝炎病毒携带者孕妇胎盘中的识别与意义.中山医科大学学报,2000;21(1):43～46.
7. ［10］Yu GJ, Zhu QR. Study on the relationship between IL-2/IL-2R and immunization failure of hepatitis B vaccine in the children with HBV intrauterine infection [J]. Chinese J Infect Dis, 1998; 16(3): 151-153.
8. 于光军,朱启容.HBV宫内感染儿童接种乙型肝炎疫苗免疫失败与IL-2及其受体的关系[J].中华传染病杂志,1998;16(3):151～153.
9. ［11］Ayoola EA, Johnson AO. Hepatitis B vaccine in pregnancy:immunogenic city, safety and transfer of antibodies to infants[J]. Int J Gynaecol Obstet, 1987; 25(4): 297 -301.
10. ［12］Hu GY, Tan WH, Wang GR The observation of effects on immunization with hepatitis B vaccine in the late period of pregnancy [J ]. Journal of Harbin Medical University, 1996;30(1) :72 -73.
11. 胡桂英,谭文华,王桂荣.妊娠后期接种乙肝疫苗免疫效果的观察[J].哈尔滨医科大学学报,1996;30(1):72～73.
12. ［13］Zhang LY, Fang ZX, Zhen ZL, Liu XY, Gong XP, Wu YX. The study of transmission route of HBV fiom father to infant [J]. Chinese J Infect Dis, 1994; 12(4): 199 -201.
13. 张丽云,方之勋,郑兆,刘新钰,龚希平,吴玉祥.父婴传播途径的初步研究[J]中华传染病杂志,1994;12(4): 199 ～201.
14. ［14］Zhao LS, Liu XS, Zhang ZX, Wang JR, Liu L, Lei BJ.Study on HBV vertical transmission via infected spermatozoa[J]. Chinese J Infect Dis, 1998; 16(3): 154 - 157.
15. 赵连三,刘晓松,张智翔,王锦蓉,刘丽,雷秉钧.乙型肝炎病毒感染经精子传播的可能性研究[J].中华传染病杂志,1998;16(3):154～157.
16. ［1］Yue YF, Yang XJ, Zhang SL, Han XB. Clinical study on the prevention of HBV transmission fiom mother to infant by injection of HBIG in pregnant women with HBsAg [J]. Chinese Journal of Practical Gynecology and Obstetrics, 1999; 15(9) :547 -548.
17. 岳亚飞,杨晓菊,张树林,韩晓兵.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):547～548.
18. ［2］Liu HY, Ma YY, Cui BX, Dal MS, Yang J. The study of mechanism about interrupting HBV transmission from mother to infant by HBIG passive immunization in pregnant women[J]. Current Advances in Obstetrics and Gynecology, 2002; 11(2): 128 -130.
19. ［3］Ruff TA, Gertig DM, Otto BF, Gust ID, Sutanto A,Soewarso TI, Kandun N, Marschner IC, Maynard JE. Lombok Hepatitis B Model Immunization Project:toward universal infant hepatitis B immunization in Indonesia [J ]. J Infect Dis,1995; 171(2): 290-296.
20. ［4］Tu SY, Wu Y, Yu DY, Wang Y, Liu QK, Hu GL, Yang WF. The study of interruption of HBV transmission from mother to infant by hepatitis B vaccine [J]. Chinese Journal of Obstetrics and Gynecology, 1991; 26(6): 358-360.
21. 涂世玺,武玉,余大勇,汪燕,刘庆宽,胡广连,杨蔚芬.乙型肝炎疫苗阻断HBV母婴传播的研究[J].中华妇产科杂志,1991;26(6):358～360.
22. ［5］Zhu QR, Yu GJ, Lu Q, Yu H, Gu XH, Zhang XZ, Dong ZQ. A study of Controlled Clinical Trial on interruption of HBV intrauterine transmission [J]. Chinese Journal of Pediatriology, 2002; 40(8): 478-480.

Chinese Journal of Evidence-Based Medicine

A Study of Reducing the Transmission of HBV from Mother to Infant in HBeAg Positive Pregnant Women

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