乙肝疫苗联合乙型肝炎免疫球蛋白接种阻断血清HBsAg阳性母亲HBV母婴传播效果分析
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摘要
目的分析乙肝疫苗联合乙型肝炎免疫球蛋白(HBIG)接种阻断血清HBsAg阳性母亲乙型肝炎病毒(HBV)母婴垂直传播的效果。方法在血清HBsAg阳性母亲所分娩的712例新生儿中,356例接受标准乙肝疫苗,另356例在接种乙肝疫苗的同时,接受HBIG接种,比较1～10岁儿童接种成功率和HBV母婴垂直传播阻断率。结果在56例1～2岁、234例3-4岁、249例5-6岁、135例7-8岁和38例9-10岁年龄组儿童,血清抗-HBs阳性率分别为89.3%、87.6%、81.1%、83.7%和76.3%,HBsAg阳性率分别为0.0%、0.4%、0.4%、1.5%和2.6%,各年龄组比较,无显著性统计学差异(P> 0.05);联合接种与乙肝疫苗接种组血清抗-HBs阳性率分别为84.3%和64.3%,血清HBsAg阳性率分别3.1%和15.2%,两组差异显著(P<0.05);在血清HBsAg/HBeAg双阳性母亲所分娩的儿童,246例联合接种组血清HBsAg阳性率为1.6%,显著低于162例只接种乙肝疫苗组的11.7%(P<0.05),而在血清HBsAg阳性母亲所分娩的儿童,110例联合接种与194例只接种乙肝疫苗组比,血清HBsAg阳性率无显著性差异(2.7%对6.2%,P>0.05)。结论对血清HBsAg/HBeAg双阳性母亲所分娩的新生儿,给予乙肝疫苗联合HBIG接种可能更有效地阻断HBV母婴垂直传播。
Objective To investigate the efficacy of combination inoculation of hepatitis B vaccine and hepatitis B immunoglobulin(HBIG) on blocking mother-to-child transmission of hepatitis B virus infection in newborn with serum HBsAg/HBeAg-positive mothers. Methods 712 newborns with serum HBsAg(n=304) or H BsAg/H BeAg-positive(n=408) mothers were inoculated with hepatitis B vaccine(n=356) or hepatitis B vaccine and HBIG combination(n=356). The children were followed-up for ten years. Results Serum anti-HBs positive rates were 89.3%,87.6%,81.1%,83.7% and 76.3% in 56 children at age of 1-2 yr,234 at of 3-4 yr,249 at of5-6 yr,135 at of 7-8 yr and 38 at of 9-10 yr,and serum HBsAg positive rates were 0.0%,0.4%,0.4%,1.5%and 2.6%,respectively,without significant differences among the five groups(P>0.05);serum anti-HBs positive rate in combination inoculation group was 84.3%,much higher,while serum HBsAg positive rate was 3.1%,much lower than in hepatitis B vaccine inoculation group(64.3% and 15.2%,respectively, P<0.05);in children with serum double HBsAg/HBeAg positive mothers,serum HBsAg positive rate in 246 children with combination inoculation was 1.6%,much lower than 11.7%(P<0.05) in 162 children with hepatitis B vaccine inoculation alone,while in children with serum HBsAg positive mothers,there was no significant difference as respect to their serum HBsAg positive rates(2.7% vs. 6.2%,P>0.05) in 110 children with combination and 194 with hepatitis B vaccine inoculation. Conclusions The hepatitis B vaccine combined with HBIG inoculation in newborns with serum double HBsAg/HBeAg positive mothers might block HBV mother to child transmission,which is worthy of clinical observation.
Objective To investigate the efficacy of combination inoculation of hepatitis B vaccine and hepatitis B immunoglobulin(HBIG) on blocking mother-to-child transmission of hepatitis B virus infection in newborn with serum HBsAg/HBeAg-positive mothers. Methods 712 newborns with serum HBsAg(n=304) or H BsAg/H BeAg-positive(n=408) mothers were inoculated with hepatitis B vaccine(n=356) or hepatitis B vaccine and HBIG combination(n=356). The children were followed-up for ten years. Results Serum anti-HBs positive rates were 89.3%,87.6%,81.1%,83.7% and 76.3% in 56 children at age of 1-2 yr,234 at of 3-4 yr,249 at of5-6 yr,135 at of 7-8 yr and 38 at of 9-10 yr,and serum HBsAg positive rates were 0.0%,0.4%,0.4%,1.5%and 2.6%,respectively,without significant differences among the five groups(P>0.05);serum anti-HBs positive rate in combination inoculation group was 84.3%,much higher,while serum HBsAg positive rate was 3.1%,much lower than in hepatitis B vaccine inoculation group(64.3% and 15.2%,respectively, P<0.05);in children with serum double HBsAg/HBeAg positive mothers,serum HBsAg positive rate in 246 children with combination inoculation was 1.6%,much lower than 11.7%(P<0.05) in 162 children with hepatitis B vaccine inoculation alone,while in children with serum HBsAg positive mothers,there was no significant difference as respect to their serum HBsAg positive rates(2.7% vs. 6.2%,P>0.05) in 110 children with combination and 194 with hepatitis B vaccine inoculation. Conclusions The hepatitis B vaccine combined with HBIG inoculation in newborns with serum double HBsAg/HBeAg positive mothers might block HBV mother to child transmission,which is worthy of clinical observation.
引文
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[14] Simonetti G,Gitto S,Golfieri L,et al. Quality of life of hepatitis B virus surface antigen-positive patients with suppressed viral replication:comparison between inactive carriers and nucleot(s)ide analog-treated patients. Eur J Gastroen Hepat,2018,16(3):1983-1987.
[15]侯春艳,杨永峰.慢性乙型肝炎抗病毒治疗新进展.实用肝脏病杂志,2017,20(1):124-128.
[16] Huang R,Wang J,Hao Y,et al. Letter:the potential risk of HBV reactivation in patients with resolved HBV infection during direct-acting antiviral therapy. Aliment Pharmacol Ther,2017,46(7):702-707.
[17] Morsica G,Bagaglio S,Spagnuolo V,et al. Immune response to hepatitis B vaccination in HIV-positive individuals with isolated antibodies against hepatitis B core antigen:Results of a prospective Italian study. Plos One,2015,62(9):536-537.
[18] Bui TTT,Tan TT,Nghiem MN,et al. Molecular characterization of hepatitis B virus in Vietnam. Bmc Infect Dis, 2017,17(1):601-609.
[19] Benyakov G,Devika K,Etzion 0,et al. A misleading pattern of serologic findings during hepatitis B virus infection. Ann Intern Med,2017,167(8):476-482.
[20] Chernet A,Yesuf A,Alagaw A. Seroprevalence of hepatitis B virus surface antigen and factors associated among pregnant women in Dawuro zone,SNNPR,Southwest Ethiopia:a cross sectional study. Bmc Res Notes,2017, 10(1):418-423.
[21] Wang H,Cai BY,Rao DL,et al. Rapid immunization effects of a new type of 60μg hepatitis B vaccine compared with traditional 20μg hepatitis B vaccines in adults. Hum Vaccin Immunother,2016,12(11):2921-2926.
[22] Shouval D,Roggendorf H,Roggendorf M. Enhanced immune response to hepatitis B vaccination through immunization with a re-S1/Pre-S2/S Vaccine. Med Microbiol Immunol, 2015,204:57-68.
[23] Leroux-Roels G,Haelterman E,Maes C,et al. Randomized trial of the immunogenicity and safety of the hepatitis B vaccine given in an accelerated schedule coadministered with the human papillomavirus type 16/18 AS04-adjuvanted cervical cancer vaccine. Clin Vaccine Immunol,2011,18(9):1510-1518.
[24] Velu V, Nandakumar S,Shanmugam S, et al. Comparison of three different recombinant hepatitis B vaccines:GeneVac-B,Engerix B and Shanvac B in high risk infants born to HBsAg positive mothers in India. World J Gastroenterol,2007,13(22):3084-3089.
[25] Yang SG,Tian G,Cui YX,et al. Factors influencing immunologic response to hepatitis B vaccine in adults. Sci Rep,2016,6:27251.
[2] Parker BD,Schurgers LJ,Brandenburg VM,et al. The associations of fibroblast growth factor 23 and uncarboxylated matrix Gla protein with mortality in coronary artery disease:the Heart and Soul Study. World J Gastroenterol,2014,20(40):14615-14619.
[3] Biondo MI,Germano V,Pietrosanti M,et al. Lack of hepatitis B virus reactivation after anti-tumour necrosis factor treatment in potential occult carriers with chronic inflammatory arthropathies.Eur J Intern Med,2014,25(5):482-484.
[4] Monjezi R,Tan SW,Tey BT,et al. Detection of hepatitis B virus core antigen by phage display mediated TaqMan real-time immuno-PCR. J Virol Methods,2013,187(1):121-126.
[5]和沁园,韩国荣,岳欣,等.乙型肝炎e抗原阴性的慢性乙型肝炎病毒感染孕妇孕期和产后肝功能异常及新生儿感染情况分析.中华实用诊断与治疗杂志,2017,31(12):1230-1232.
[6] Jaramillo CM, De FLH,Porras A, et al. Characterization of hepatitis B virus in Amerindian children and mothers from Amazonas State,Colombia. Plos One,2017,12(10):1816-1823.
[7] Apiung T,Ndanu TA,Mingle JA,et al. Hepatitis B virus surface antigen and antibody markers in children at a major paediatric hospital after the pentavalent DTP-HBV-Hib vaccination. J Intensive Care Med,2017,51(1):13-18.
[8] Pfefferkorn M,Bohm S,Schott T,et al. Quantification of large and middle proteins of hepatitis B virus surface antigen(HBsAg)as a novel tool for the identification of inactive HBV carriers. Gut,2017,31(16):31-38.
[9] Blanch L,Sales B,Montanya J,et al. Validation of the Better Care,system to detect ineffective efforts during expiration in mechanically ventilated patients:a pilot study. J Intensive Care Med,2012,38(5):772-780.
[10] Alidjinou EK,Michel C,Canva V,et al. Very slow decline of hepatitis B virus surface antigen and core related antigen in chronic hepatitis B patients successfully treated with nucleos(t)ide analogues. J Med Virol,2018,13(21):2469-2475.
[11] Han W,Ni Q,Liu K,et al. Decreased CD122 on CD56 dim,NK associated with its impairment in asymptomatic chronic HBV carriers with high levels of HBV DNA,HBsAg and HBeAg. Life Sci,2018,22(8):53-60.
[12]马勇.乙型肝炎病毒携带孕妇乳汁和血清HBV DNA载量与婴儿感染率的关系分析.实用肝脏病杂志,2017,20(4):486-487.
[13] Fuchino M,Tajiri K,Minemura M,et al. Vanishing tumor in a liver graft from a hepatitis B virus surface antigen-positive donor. J Intensive Care Med,2017,11(3):610-615.
[14] Simonetti G,Gitto S,Golfieri L,et al. Quality of life of hepatitis B virus surface antigen-positive patients with suppressed viral replication:comparison between inactive carriers and nucleot(s)ide analog-treated patients. Eur J Gastroen Hepat,2018,16(3):1983-1987.
[15]侯春艳,杨永峰.慢性乙型肝炎抗病毒治疗新进展.实用肝脏病杂志,2017,20(1):124-128.
[16] Huang R,Wang J,Hao Y,et al. Letter:the potential risk of HBV reactivation in patients with resolved HBV infection during direct-acting antiviral therapy. Aliment Pharmacol Ther,2017,46(7):702-707.
[17] Morsica G,Bagaglio S,Spagnuolo V,et al. Immune response to hepatitis B vaccination in HIV-positive individuals with isolated antibodies against hepatitis B core antigen:Results of a prospective Italian study. Plos One,2015,62(9):536-537.
[18] Bui TTT,Tan TT,Nghiem MN,et al. Molecular characterization of hepatitis B virus in Vietnam. Bmc Infect Dis, 2017,17(1):601-609.
[19] Benyakov G,Devika K,Etzion 0,et al. A misleading pattern of serologic findings during hepatitis B virus infection. Ann Intern Med,2017,167(8):476-482.
[20] Chernet A,Yesuf A,Alagaw A. Seroprevalence of hepatitis B virus surface antigen and factors associated among pregnant women in Dawuro zone,SNNPR,Southwest Ethiopia:a cross sectional study. Bmc Res Notes,2017, 10(1):418-423.
[21] Wang H,Cai BY,Rao DL,et al. Rapid immunization effects of a new type of 60μg hepatitis B vaccine compared with traditional 20μg hepatitis B vaccines in adults. Hum Vaccin Immunother,2016,12(11):2921-2926.
[22] Shouval D,Roggendorf H,Roggendorf M. Enhanced immune response to hepatitis B vaccination through immunization with a re-S1/Pre-S2/S Vaccine. Med Microbiol Immunol, 2015,204:57-68.
[23] Leroux-Roels G,Haelterman E,Maes C,et al. Randomized trial of the immunogenicity and safety of the hepatitis B vaccine given in an accelerated schedule coadministered with the human papillomavirus type 16/18 AS04-adjuvanted cervical cancer vaccine. Clin Vaccine Immunol,2011,18(9):1510-1518.
[24] Velu V, Nandakumar S,Shanmugam S, et al. Comparison of three different recombinant hepatitis B vaccines:GeneVac-B,Engerix B and Shanvac B in high risk infants born to HBsAg positive mothers in India. World J Gastroenterol,2007,13(22):3084-3089.
[25] Yang SG,Tian G,Cui YX,et al. Factors influencing immunologic response to hepatitis B vaccine in adults. Sci Rep,2016,6:27251.