De Groote J J
Department of Hepatology, Universitair Ziekenhuis Gasthuisberg, Katholieke Universiteit Leuven, Belgium.
Postgrad Med J. 1987;63 Suppl 2:33-9.
Hepatitis B postexposure prophylaxis is here reviewed. Every contact with hepatitis B virus can cause an infection which may be either acute, subclinical, or progressive, the latter potentially leading to chronic liver disease and hepatocellular carcinoma. Direct injection of large quantities of HBsAg-positive blood is almost invariably contagious. While casual person-to-person contact rarely causes disease, the multiplicity of exposure in the hospital environment or the home increases the risk for transmission. Several studies have shown that postexposure prophylaxis using passive immunization with specific hepatitis B antibodies is possible. Hepatitis B immune globulin (HBIG) with a minimum titre of 100 IU/ml should be used. In practice, most preparations contain 500 IU/ml. The use of HBIG post-exposure prophylaxis should be limited to needlestick injury, sexual exposure, and perinatal contact of neonates with HBsAg-positive mothers. Routine vaccination as an adjunct to HBIG administration is recommended. HBIG does not decrease the immunogenic properties of the vaccine provided that the injection is not made at the same site. With increasing use of hepatitis B vaccines, the need for therapeutic intervention will hopefully be considerably diminished. Prevention rather than therapy should be stressed.
本文对乙肝暴露后预防进行了综述。每次接触乙肝病毒都可能导致感染，感染类型可能为急性、亚临床或进行性，后者可能会发展为慢性肝病和肝细胞癌。直接注射大量乙肝表面抗原（HBsAg）阳性血液几乎总会导致传染。虽然一般的人际接触很少引发疾病，但在医院环境或家庭中接触机会较多，会增加传播风险。多项研究表明，使用特异性乙肝抗体进行被动免疫来进行暴露后预防是可行的。应使用最低效价为100国际单位/毫升的乙肝免疫球蛋白（HBIG）。实际上，大多数制剂的效价为500国际单位/毫升。HBIG暴露后预防应仅限于针刺伤、性接触以及新生儿与HBsAg阳性母亲的围产期接触。建议将常规疫苗接种作为HBIG接种的辅助措施。只要不在同一部位注射，HBIG不会降低疫苗的免疫原性。随着乙肝疫苗使用的增加，治疗干预的需求有望大幅减少。应强调预防而非治疗。
