联合免疫阻断乙型肝炎病毒母婴传播效果及影响因素研究
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摘要
目的观察乙型肝炎(乙肝)疫苗与乙肝免疫球蛋白(HBIG)联合免疫阻断乙肝病毒(HBV)母婴传播的效果,探讨母婴阻断失败的影响因素。方法以山东省寿光市2005-2015年HBV感染者母亲及所生的儿童为研究对象,采取问卷调查和血清采集,应用ELISA检测HBV血清学5项指标,母亲及儿童的感染状况以随访检测结果为准。检测结果判定以儿童乙肝表面抗原(HBsAg)阳性为阻断失败。结果共调查儿童1 372名,母婴阻断失败率2.92%。其中,乙肝疫苗与HBIG联合免疫阻断失败率2.23%,单用乙肝疫苗阻断失败率6.67%;10μg酵母乙肝疫苗与HBIG联合免疫阻断失败率1.77%,5μg酵母乙肝疫苗与HBIG联合免疫阻断失败率4.41%。母亲乙型肝炎e抗原(HBeAg)阳性、生育年龄、生育方式等是阻断失败的主要影响因素,而儿童性别、喂养方式、孕晚期母亲是否接种HBIG、儿童出生后接种HBIG的次数等与阻断失败率无相关性。结论 HBV母婴阻断效果,乙肝疫苗与HBIG联合免疫优于未联合免疫,10μg酵母乙肝疫苗优于5μg乙肝疫苗,建议进一步开展大剂量乙肝疫苗与HBIG联合免疫研究。
Objective To observe the efficacy of hepatitis B vaccine combined with hepatitis B immunoglobulin(HBIG)on preventing hepatitis B virus(HBV)mother-to-child transmission,and to analyze the influencing factors of the prevention failure. Methods Mothers with HBV infection and their children born from 2005 to2015 were enrolled into the study.A questionnaire survey was conducted and blood samples were collected.ELISA was used to detect the serological markers of HBV.The blocking failure was defined if the child was HBsAg positive. Results 1 372 children were surveyed with the overall blocking failure rate of 2.92%.The blocking failure rate was 2.23%for combined immunization,6.67%for hepatitis B vaccine only,1.77%for combined immunization of 10μg yeast hepatitis B vaccine with HBIG and was 5.11%for combined immunization of 5μg yeast hepatitis B vaccine with HBIG.The major influencing factors of the blocking failure were hepatitis B e antigen(HBeAg)positive of mothers,age of childbearing and method of delivery,while child′s gender,way of feeding,HBIG usage of mother and children were factors unrelated to blocking failure. Conclusions The blocking effect of hepatitis B vaccine combined with HBIG is significantly better than that of hepatitis B vaccine alone,also the 10μg yeast hepatitis B vaccine works better than the 5μg hepatitis B vaccine.It is suggested a high dose of hepatitis B vaccine combined with HBIG should be used for blocking the transmission of hepatitis B virus from mother to baby.
Objective To observe the efficacy of hepatitis B vaccine combined with hepatitis B immunoglobulin(HBIG)on preventing hepatitis B virus(HBV)mother-to-child transmission,and to analyze the influencing factors of the prevention failure. Methods Mothers with HBV infection and their children born from 2005 to2015 were enrolled into the study.A questionnaire survey was conducted and blood samples were collected.ELISA was used to detect the serological markers of HBV.The blocking failure was defined if the child was HBsAg positive. Results 1 372 children were surveyed with the overall blocking failure rate of 2.92%.The blocking failure rate was 2.23%for combined immunization,6.67%for hepatitis B vaccine only,1.77%for combined immunization of 10μg yeast hepatitis B vaccine with HBIG and was 5.11%for combined immunization of 5μg yeast hepatitis B vaccine with HBIG.The major influencing factors of the blocking failure were hepatitis B e antigen(HBeAg)positive of mothers,age of childbearing and method of delivery,while child′s gender,way of feeding,HBIG usage of mother and children were factors unrelated to blocking failure. Conclusions The blocking effect of hepatitis B vaccine combined with HBIG is significantly better than that of hepatitis B vaccine alone,also the 10μg yeast hepatitis B vaccine works better than the 5μg hepatitis B vaccine.It is suggested a high dose of hepatitis B vaccine combined with HBIG should be used for blocking the transmission of hepatitis B virus from mother to baby.
引文
[1]王富珍,郑徽,张国民,等.中国2014年HBsAg阳性母亲所生1-14岁儿童乙型肝炎血清流行病学特征分析[J].中华流行病学杂志,2017,38(4):457-461.
[2]姜洁,戴生龙,徐建芳,等.江苏省2010-2015年乙型肝炎母婴阻断效果的随访研究[J].中华流行病学杂志,2016,37(10):1345-1349.
[3]单芙香,刘刚,卢紫燕,等.深圳市乙肝母婴阻断效果血清学调查分析[J].中国预防医学杂志,2015,16(4):320-321.
[4]徐玲,陈海明,杜国明.乙肝疫苗和免疫球蛋白阻断乙肝母婴传播效果研究[J].医学动物防制,2017,33(5):521-522,525.
[5]张磊,桂希恩,汪波,等.免疫阻断乙型肝炎病毒母婴传播多中心研究[J].中国实用妇科与产科杂志,2015,31(1):65-68.
[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):2354-2357.
[7]王明儒,刘中芹,王晓琼,等.HBsAg阳性者乙肝病毒血清标志物的组合模式及e抗原阳性者年龄和性别分布[J].疾病预防控制通报,2015,30(2):12-14.
[8]李根瑞,陈涓涓,谢正媛,等.云南省7934例农村育龄人群乙型肝炎病毒标记物血清学筛查检测结果分析[J].中国预防医学杂志,2017,18(1):31-34.
[9]范祎,肖小敏.分娩方式对乙肝病毒母婴垂直传播影响的Meta分析[J].中国妇幼保健,2007,22(27):3787-3789.
[10]王川,武兴,王崇,等.HBV母婴传播阻断效果及影响因素分析[J].临床肝胆病杂志,2015,31(8):1238-1245.
[11]崔富强,王富珍,郑徽,等.接种不同剂量重组乙型肝炎疫苗(酵母)阻断乙型肝炎病毒母婴传播的评价[J].中国计划免疫,2007,13(4):289-292.
[12]刘中芹,王晓琼,郭昊,等.乙型肝炎疫苗低/无应答婴儿不同剂量和剂次再免疫效果及持久性观察[J].微生物学与免疫学进展,2015,43(6):36-39.
[13]谢若欣,杨洁芳,霍乐颍.不同剂量乙肝免疫球蛋白联合乙肝疫苗阻断乙肝病毒母婴传播的疗效比较[J].中国临床新医学,2015,8(8):754-757.
[14]单芙香,刘刚,卢紫燕,等.深圳市乙肝母婴阻断效果血清学调查分析[J].中国预防医学杂志,2015,16(4):320-321.
[2]姜洁,戴生龙,徐建芳,等.江苏省2010-2015年乙型肝炎母婴阻断效果的随访研究[J].中华流行病学杂志,2016,37(10):1345-1349.
[3]单芙香,刘刚,卢紫燕,等.深圳市乙肝母婴阻断效果血清学调查分析[J].中国预防医学杂志,2015,16(4):320-321.
[4]徐玲,陈海明,杜国明.乙肝疫苗和免疫球蛋白阻断乙肝母婴传播效果研究[J].医学动物防制,2017,33(5):521-522,525.
[5]张磊,桂希恩,汪波,等.免疫阻断乙型肝炎病毒母婴传播多中心研究[J].中国实用妇科与产科杂志,2015,31(1):65-68.
[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):2354-2357.
[7]王明儒,刘中芹,王晓琼,等.HBsAg阳性者乙肝病毒血清标志物的组合模式及e抗原阳性者年龄和性别分布[J].疾病预防控制通报,2015,30(2):12-14.
[8]李根瑞,陈涓涓,谢正媛,等.云南省7934例农村育龄人群乙型肝炎病毒标记物血清学筛查检测结果分析[J].中国预防医学杂志,2017,18(1):31-34.
[9]范祎,肖小敏.分娩方式对乙肝病毒母婴垂直传播影响的Meta分析[J].中国妇幼保健,2007,22(27):3787-3789.
[10]王川,武兴,王崇,等.HBV母婴传播阻断效果及影响因素分析[J].临床肝胆病杂志,2015,31(8):1238-1245.
[11]崔富强,王富珍,郑徽,等.接种不同剂量重组乙型肝炎疫苗(酵母)阻断乙型肝炎病毒母婴传播的评价[J].中国计划免疫,2007,13(4):289-292.
[12]刘中芹,王晓琼,郭昊,等.乙型肝炎疫苗低/无应答婴儿不同剂量和剂次再免疫效果及持久性观察[J].微生物学与免疫学进展,2015,43(6):36-39.
[13]谢若欣,杨洁芳,霍乐颍.不同剂量乙肝免疫球蛋白联合乙肝疫苗阻断乙肝病毒母婴传播的疗效比较[J].中国临床新医学,2015,8(8):754-757.
[14]单芙香,刘刚,卢紫燕,等.深圳市乙肝母婴阻断效果血清学调查分析[J].中国预防医学杂志,2015,16(4):320-321.