Hepatitis B immunoglobulin injection in pregnancy to interrupt hepatitis B virus mother-to-child transmission-a meta-analysis
Hepatitis B immunoglobulin injection in pregnancy to interrupt hepatitis B virus mother-to-child transmission-a meta-analysis
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DOI：
10.1016/j.ijid.2009.09.008
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发表时间：
2010-07-01
影响因子：
8.4
通讯作者：
Yang, Yuebo
中科院分区：
文献类型：
--
作者：
Shi, Zhongjie;Li, Xiaomao;Yang, Yuebo
目的：目的评价妊娠期应用B免疫球蛋白（HBIG）预防B肝炎病毒母婴传播（MTCT）的有效性和安全性。检索了多个数据库，并联系了该领域的专家。通过Jadad评分评估每个RCT的方法学质量。我们提取了HBV宫内感染、母婴传播、治疗方法、新生儿免疫预防方法和不良反应的数据。所有分析采用Mantel-Haenszel随机效应模型，使用比值比（OR）和95%置信区间（95%CI）。结果：纳入了来自37项合格RCT的5900例无症状B表面抗原（HBsAg）血清阳性母亲的新生儿。与对照组相比，HBIG组新生儿宫内感染率较低32项随机对照试验中，HBsAg的OR为0.22，95% CI [0.17，0.29]; 13项随机对照试验中，HBV DNA的OR为0.15，95% CI [0.07，0.30];两者p < 0.01）和更高的保护率（由B型肝炎表面抗体（HBVAb）表示，来自15个RCT的OR为11.79，95%CI [4.69，29.61]; p < 0.01）。在出生后9-12个月的MTCT中发现了相同的趋势，由HBsAg（OR 0.33，95% CI [0.21，0.51]，来自9项RCT; p < 0.01）和抗HBsAg抗体（OR 2.49，95% CI [1.55，4.01]，来自11项RCT; p < 0.01）表示。HBIG似乎是安全的，但少数RCT报告了不良事件。结论：在HBV携带者母亲妊娠晚期多次注射HBIG，具有高度的传染性，有效和安全地预防HBV宫内传播。(C)2010年国际传染病学会。由爱思唯尔有限公司出版。保留所有权利。
Objectives: To evaluate the efficacy and safety of using hepatitis B immunoglobulin (HBIG) during pregnancy to prevent hepatitis B virus (HBV) mother-to-child transmission (MTCT).Methods: We systematically reviewed the effect of HBIG in decreasing HBV MTCT from randomized controlled trials (RCTs) carried out between January 1990 and December 2008, in English and Chinese languages. Multiple databases were searched, and experts in this field were contacted. The methodological quality of each RCT was assessed by the Jadad score. We abstracted data on HBV intrauterine infection, MTCT, treatment methods, newborn immune prophylaxis methods, and adverse effects. A Mantel-Haenszel random-effects model was employed for all analyses using odds ratios (OR) and 95% confidence intervals (95% CI).Results: Five thousand nine hundred newborns of asymptomatic hepatitis B surface antigen (HBsAg)seropositive mothers from 37 qualified RCTs were included. Compared with the control group, newborns in the HBIG group had a lower intrauterine infection rate (indicated by HBsAg as OR 0.22, 95% CI [0.17, 0.29], from 32 RCTs; indicated by HBV DNA as OR 0.15, 95% CI [0.07, 0.30], from 13 RCTs; p < 0.01 for both) and a higher protection rate (indicated by hepatitis B surface antibody (HBsAb) as OR 11.79, 95% CI [4.69, 29.61], from 15 RCTs; p < 0.01). The same trend was found in MTCT by the time of 9-12 months after birth, indicated by HBsAg (OR 0.33, 95% CI [0.21, 0.51], from nine RCTs; p < 0.01) and HBsAb (OR 2.49, 95% CI [1.55, 4.01], from 11 RCTs; p < 0.01). HBIG appears to be safe, but a few RCTs have reported adverse events.Conclusion: Multiple injections of HBIG in HBV carrier mothers with a high degree of infectiousness in late pregnancy, effectively and safely prevent HBV intrauterine transmission. (C) 2010 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.