探讨免疫预防乙型肝炎病毒母婴传播的效果及影响因素
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摘要
目的探讨免疫预防阻断乙型肝炎病毒母婴传播的效果及影响因素。方法选取2014年4月-2017年1月来疾控中心门诊注射疫苗母亲为HBsAg阳性的新生儿,共计101例,在新生儿8~12月龄时检测HBV血清标志物。结果随访101例HBsAg阳性母亲所产新生儿,发现HBsAg阳性8例,免疫阻断失败率为7.92%;HBsAb阳性61例,HbsAb阳性率为60.40%;HBeAg阳性孕妇免疫阻断失败率为15.38%,高于HBeAg阴性孕妇(χ2=6.213,P=0.013);HBV DNA阳性孕妇免疫阻断失败率为10.39%,高于HBV DNA阴性孕妇(χ2=4.041,P=0.044);新生儿仅疫苗预防的免疫阻断失败率为23.33%,高于免疫方式为疫苗+HBIG的新生儿(χ2=11.056,P=0.001);多因素Logistic回归分析结果显示,孕妇HBeAg状态、新生儿免疫方式是免疫阻断失败的独立影响因素(OR=1.988,1.706;P=0.002,0.004)。结论免疫预防乙型肝炎病毒母婴传播的效果较好,其中孕妇HBeAg状态及新生儿免疫方式对免疫阻断效果有一定影响。
OBJECTIVE To explore the effect of immunization on prevention of mother to infant transmission of hepatitis B virus(HBV)and investigate the influencing factors.METHODS A total of 101 neonates whose mothers were positive for HBsAg and vaccinated in outpatient departments of the center for disease control and prevention from Apr 2014 to Jan 2017 were enrolled in the study,and the serum markers of HBV of the neonates were detected at the age of 8-12 months.RESULTS The result of a follow-up showed that of the 101 neonates whose mothers were positive for HBsAg,8 were positive for HBsAg,and the rate of failure of immune block was 7.92%;61 were positive for HBsAb,with the positive rate of HBsAb 60.40%.The rate of failure of immune block of the HBeAg-positive pregnant women was 15.38%,significantly higher than that of the HBeAg-negative pregnant women(χ2=6.213,P=0.013).The rate of failure of immune block of the HBV DNA-positive pregnant women was 10.39%,significantly higher than that of the HBV DNA-negative pregnant women(χ2=4.041,P=0.044).The rate of failure of immune block of the neonates who were only vaccinated for prevention was 23.33%,significantly higher than that of the neonates who had vaccination plus HBIG(χ2=11.056,P=0.001).The result of multivariate logistic regression analysis showed that the status of HBeAg of pregnant women and immunization modes were the independent influencing factors for the failure of immune block(OR=1.988,1.706;P=0.002,0.004).CONCLUSIONThe immunization may achieve remarkable effect on prevention of mother to infant transmission of HBV;the status of HBeAg of pregnant women and immunization mode have certain impact on the immune block.
OBJECTIVE To explore the effect of immunization on prevention of mother to infant transmission of hepatitis B virus(HBV)and investigate the influencing factors.METHODS A total of 101 neonates whose mothers were positive for HBsAg and vaccinated in outpatient departments of the center for disease control and prevention from Apr 2014 to Jan 2017 were enrolled in the study,and the serum markers of HBV of the neonates were detected at the age of 8-12 months.RESULTS The result of a follow-up showed that of the 101 neonates whose mothers were positive for HBsAg,8 were positive for HBsAg,and the rate of failure of immune block was 7.92%;61 were positive for HBsAb,with the positive rate of HBsAb 60.40%.The rate of failure of immune block of the HBeAg-positive pregnant women was 15.38%,significantly higher than that of the HBeAg-negative pregnant women(χ2=6.213,P=0.013).The rate of failure of immune block of the HBV DNA-positive pregnant women was 10.39%,significantly higher than that of the HBV DNA-negative pregnant women(χ2=4.041,P=0.044).The rate of failure of immune block of the neonates who were only vaccinated for prevention was 23.33%,significantly higher than that of the neonates who had vaccination plus HBIG(χ2=11.056,P=0.001).The result of multivariate logistic regression analysis showed that the status of HBeAg of pregnant women and immunization modes were the independent influencing factors for the failure of immune block(OR=1.988,1.706;P=0.002,0.004).CONCLUSIONThe immunization may achieve remarkable effect on prevention of mother to infant transmission of HBV;the status of HBeAg of pregnant women and immunization mode have certain impact on the immune block.
引文
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[9]Huang X,Zhou L,Mu LH,et al.Efficacy of hepatitis B immunoprophylaxis in children at high risk of hepatitis B and risk factors for mother-to-child transmission of hepatitis B virus[J].Zhongguo Dang Dai Er Ke Za Zhi,2016,18(5):410-414.
[10]彭美莲,刘玮,吕雯,等.替比夫定与乙型肝炎疫苗及免疫球蛋白联合阻断乙型肝炎病毒母婴垂直传播的研究[J].中华医院感染学杂志,2014,24(1):15-16.
[11]Wei KP,Zhu FC,Liu JX,et al.The efficacy of two different dosages of hepatitis B immunoglobulin combined with hepatitis B vaccine in preventing mother-to-child transmission of hepatitis B virus:aprospective cohort study[J].Vaccine,2018,36(2):256-263.
[12]Zhu FC,Sun KX,Pan HX,et al.The immunogenicity in healthy infants and efficiency to prevent mother to child transmission of Hepatitis B virus of a 10μg recombinant yeast-derived Hepatitis B vaccine(Hep-KSC).[J].Vaccine,2016,34(24):2656-2662.
[13]Eke CB,Onyire NB,Amadi OF.Prevention of mother to child transmission of hepatitis B virus infection in Nigeria:a call to action[J].Niger J Paediatr,2016,43(3):201.
[14]Wen WH,Lai MW,Chang MH.A review of strategies to prevent mother-to-infant transmission of hepatitis B virus infection[J].Expert Rev Gastroenterol Hepatol,2016,10(3):317-330.
[15]王富珍,崔富强.乙型肝炎病毒母婴阻断免疫预防策略综述[J].中国疫苗和免疫,2014,31(4):355-359.
[16]贾涛,王锐.乙型肝炎病毒母婴阻断研究进展及对策[J].中华预防医学杂志,2016,16(2):197-200.
[2]廖华,朱琳燕.拉米夫定联合乙肝免疫球蛋白阻断乙型肝炎病毒母婴传播的临床观察[J].中国药房,2014,25(32):3010-3012.
[3]Eke AC,Eleje GU,Eke UA,et al.Hepatitis B immunoglobulin during pregnancy for prevention of mother-to-child transmission of hepatitis B virus[J].Cochrane Database Syst Rev,2017,2(6):CD008545.
[4]庄辉.预防乙型肝炎病毒母婴传播中值得注意的几个问题[J].中华肝脏病杂志,2016,24(12):881-884.
[5]Weis N,Cowan S,Hallager S,et al.Vertical transmission of hepatitis B virus during pregnancy and delivery in Denmark[J].Scand J Gastroenterol,2017,52(2):178-184.
[6]金美玉,全顺爱,郑世梅,等.乙型肝炎免疫球蛋白联合乙型肝炎疫苗阻断乙型肝炎病毒母婴传播的研究[J].中华医院感染学杂志,2016,26(10):2354-2356.
[8]彭美莲,刘玮,吕雯,等.替比夫定与乙型肝炎疫苗及免疫球蛋白联合阻断乙型肝炎病毒母婴垂直传播的研究[J].中华医院感染学杂志,2014,24(1):15-16.
[9]Huang X,Zhou L,Mu LH,et al.Efficacy of hepatitis B immunoprophylaxis in children at high risk of hepatitis B and risk factors for mother-to-child transmission of hepatitis B virus[J].Zhongguo Dang Dai Er Ke Za Zhi,2016,18(5):410-414.
[10]彭美莲,刘玮,吕雯,等.替比夫定与乙型肝炎疫苗及免疫球蛋白联合阻断乙型肝炎病毒母婴垂直传播的研究[J].中华医院感染学杂志,2014,24(1):15-16.
[11]Wei KP,Zhu FC,Liu JX,et al.The efficacy of two different dosages of hepatitis B immunoglobulin combined with hepatitis B vaccine in preventing mother-to-child transmission of hepatitis B virus:aprospective cohort study[J].Vaccine,2018,36(2):256-263.
[12]Zhu FC,Sun KX,Pan HX,et al.The immunogenicity in healthy infants and efficiency to prevent mother to child transmission of Hepatitis B virus of a 10μg recombinant yeast-derived Hepatitis B vaccine(Hep-KSC).[J].Vaccine,2016,34(24):2656-2662.
[13]Eke CB,Onyire NB,Amadi OF.Prevention of mother to child transmission of hepatitis B virus infection in Nigeria:a call to action[J].Niger J Paediatr,2016,43(3):201.
[14]Wen WH,Lai MW,Chang MH.A review of strategies to prevent mother-to-infant transmission of hepatitis B virus infection[J].Expert Rev Gastroenterol Hepatol,2016,10(3):317-330.
[15]王富珍,崔富强.乙型肝炎病毒母婴阻断免疫预防策略综述[J].中国疫苗和免疫,2014,31(4):355-359.
[16]贾涛,王锐.乙型肝炎病毒母婴阻断研究进展及对策[J].中华预防医学杂志,2016,16(2):197-200.