HBV母婴传播影响因素及乙肝高危儿免疫预防的效果观察
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摘要
目的探讨乙肝高危儿免疫预防的效果及母婴传播的影响因素,为降低儿童乙肝感染率提供参考依据。方法回顾性分析湖南省妇幼保健院于2012年8月-2016年1月收治的431例HBsAg阳性产妇及其1~5岁的452例乙肝高危儿的临床资料,通过检测乙肝高危儿的乙肝标志物,分析HBV母婴传播的影响因素及免疫预防效果。结果 452例乙肝高危儿全部规范接种了乙肝疫苗(0-1-6),94.91%(429/452)高危儿联合注射了乙肝免疫球蛋白(HBIG);经检测,19例儿童HBsAg阳性,感染率4.20%;联合免疫乙肝高危儿感染率为1.40%(6/429),单纯免疫乙肝感染率为56.52%(13/23),比较差异有统计学意义(P=0.000);不同年龄段乙肝高危儿感染率差异无统计学意义(P=0.971),但随着年龄增加,HBs Ab阳性率逐渐下降(P=0.000);对HBV母婴传播影响因素进行单因素分析结果显示,母亲HBeAg阳性、HBVDNA拷贝量≥106与均会导致高危儿感染率升高(P=0.000);对上述两组影响因素进行多因素logistic回归分析显示,母亲HBeAg阳性、HBV-DNA拷贝量≥106是导致母婴传播的独立危险因素。结论母体HBeAg阳性、HBV-DNA拷贝量≥106是导致母婴传播的独立危险因素,孕期应加强预防干预,降低婴儿乙肝感染率;在高危儿生长发育过程中要加强HBs Ab监测,维持机体乙肝抗体水平。
Objective To explore the efficacy of hepatitis B immunoprophylaxis and the factors influencing mother-to-child transmission of hepatitis B virus in children at high risk of hepatitis B so as to provide a basis for declining the infection rate of hepatitis B in children.Methods We retrospectively analyzed the clinical data regarding 431 HBsAg-positive mothers and their452 children aged 1-5 years at high risk of hepatitis B hospitalized in Hunan Provincial Maternal and Child Health Hospital from August 2012 to January 2016.Hepatitis B markers in the children were detected,and the factors influencing mother-to-child transmission of hepatitis B virus and the efficacy of hepatitis B immunoprophylaxis were analyzed.Results The 452 children at high risk of hepatitis B all received a full course of HBV vaccination,and 94.91% (429/452) were injected with hepatitis B immunoglobulin (HBIG).The infection rate of HBsAg was 4.20% (19/452) for total,and significantly lower in children with combined immunization (1.40%,6/429) than in those with single immunization (56.52%,13/23) (P = 0.000).It was not significantly different among different age groups (P = 0.971).HBs Ab positive rate decreased gradually with the increase of age (P =0.000).Univariate analysis showed that HBeAg-positive mothers and HBV-DNA copy ≥ 106 could result in higher infection rate in the high risk children (P = 0.000).Multivariate logistic regression analysis showed that HBeAg-positive mothers and HBV-DNA copy ≥ 106 were the independent risk factors of mother-to-child transmission of hepatitis B virus.Conclusions HBeAg-positive mothers and HBV-DNA copy ≥ 106 are the independent risk factors for mother-to-child transmission of hepatitis B virus.It is necessary to strengthen prevention and intervention during pregnancy so as to decline the infection rate of hepatitis B in infants.More attention should be paid to intensify HBs Ab monitoring during the growth and development of children at high risk of hepatitis B and maintain the antibody level against hepatitis B virus.
Objective To explore the efficacy of hepatitis B immunoprophylaxis and the factors influencing mother-to-child transmission of hepatitis B virus in children at high risk of hepatitis B so as to provide a basis for declining the infection rate of hepatitis B in children.Methods We retrospectively analyzed the clinical data regarding 431 HBsAg-positive mothers and their452 children aged 1-5 years at high risk of hepatitis B hospitalized in Hunan Provincial Maternal and Child Health Hospital from August 2012 to January 2016.Hepatitis B markers in the children were detected,and the factors influencing mother-to-child transmission of hepatitis B virus and the efficacy of hepatitis B immunoprophylaxis were analyzed.Results The 452 children at high risk of hepatitis B all received a full course of HBV vaccination,and 94.91% (429/452) were injected with hepatitis B immunoglobulin (HBIG).The infection rate of HBsAg was 4.20% (19/452) for total,and significantly lower in children with combined immunization (1.40%,6/429) than in those with single immunization (56.52%,13/23) (P = 0.000).It was not significantly different among different age groups (P = 0.971).HBs Ab positive rate decreased gradually with the increase of age (P =0.000).Univariate analysis showed that HBeAg-positive mothers and HBV-DNA copy ≥ 106 could result in higher infection rate in the high risk children (P = 0.000).Multivariate logistic regression analysis showed that HBeAg-positive mothers and HBV-DNA copy ≥ 106 were the independent risk factors of mother-to-child transmission of hepatitis B virus.Conclusions HBeAg-positive mothers and HBV-DNA copy ≥ 106 are the independent risk factors for mother-to-child transmission of hepatitis B virus.It is necessary to strengthen prevention and intervention during pregnancy so as to decline the infection rate of hepatitis B in infants.More attention should be paid to intensify HBs Ab monitoring during the growth and development of children at high risk of hepatitis B and maintain the antibody level against hepatitis B virus.
引文
[1]黄歆,周莉,牟李红,等.乙型肝炎高危儿免疫预防效果及乙肝病毒母婴传播影响因素分析[J].中国当代儿科杂志,2016,18(5):410-414.
[2]Liu K,Cui N,Fang LQ,et al.Epidemiologic features and environmental risk factors of severe fever with thrombocytopenia syndrome,Xinyang,China[J].PLo S Negl Trop Dis,2014,8(5):e2820.
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[10]丁霄雁,耿慧,段彼得,等.乙型肝炎病毒感染免疫预防母婴传播的效果评估[J].中华医院感染学杂志,2015,25(7):1657-1659.
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[12]Delorme-Axford E,Sadovsky Y,Coyne CB.The placenta as a barrier to viral infections[J].Annu Rev V,2014,1(1):133-146.
[13]Walker TY,Smith EA,Fenlon N,et al.Characteristics of pregnant women with hepatitis B virus infection in 5 US public health jurisdictions,2008-2012[J].Public Health Rep,2016,131(5):685-694.
[14]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.
[15]Zhang L,Gui X,Fan J,et al.Breast feeding and immunoprophylaxis efficacy of mother-to-child transmission of hepatitis B virus[J].J Matern Fetal Neonatal Med,2014,27(2):182-186.
[16]Pinto M,Dawar M,Krajden M,et al.Will infant hepatitis B vaccination protect into adulthood?Extended Canadian experience after a 2,4,6 month immunization schedule[J].Pediatr Infect Dis J,2017,883-885.
[17]罗灿,汤柳英,王雄虎,等.乙型肝炎病毒母婴传播影响因素的研究进展[J].中国妇幼卫生杂志,2016,7(1):72-75.
[18]Dini G,Toletone A,Barberis I,et al.Persistence of protective antiHBs antibody levels and anamnestic response to HBV booster vaccination:a cross-sectional study among healthcare students 20 years following the universal immunization campaign in Italy[J].Hum Vaccin Immunother,2017,13(2):440-444.
[19]陈旭,陈洁.乙型肝炎病毒母婴传播及其预防的研究进展[J].现代妇产科进展,2014,23(10):844-848.
[20]唐洁,许联红,陈洁,等.新生儿免疫预防乙型肝炎病毒母婴传播的效果及传播易患因素分析[J].中国妇幼保健,2014,29(21):3427-3430.
[2]Liu K,Cui N,Fang LQ,et al.Epidemiologic features and environmental risk factors of severe fever with thrombocytopenia syndrome,Xinyang,China[J].PLo S Negl Trop Dis,2014,8(5):e2820.
[3]Croagh CM,Lubel JS.Natural history of chronic hepatitis B:phases in a complex relationship[J].World J Gastroenterol,2014,20(30):10395-10404.
[4]Aghasadeghi MR,Velayati AA,Mamishi S,et al.Low prevalence of hepatitis B vaccine escape mutants among individuals born after the initiation of a nationwide vaccination program in Iran[J].Arch Virol,2016,161(12):3405-3411.
[5]眭志祥,袁卫建,郑彬,等.丹阳市乙肝疫苗联合免疫球蛋白母婴阻断效果分析[J].实用预防医学,2017,24(4):385-387.
[6]Khuroo MS,Khuroo MS,Khuroo NS.Transmission of hepatitis E virus in developing countries[J].Viruses,2016,8(9):109-114.
[7]Crawford NW,Barfield C,Hunt RW,et al.Improving preterm infants'immunization status:a follow-up audit[J].J Paediatr Child Health,2014,50(4):314-318.
[8]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):65-69.
[9]李庆彦,李庆方,刘春华,等.联合免疫后乙型肝炎病毒感染母婴传播相关因素的临床研究[J].中华医院感染学杂志,2016,26(2):424-426.
[10]丁霄雁,耿慧,段彼得,等.乙型肝炎病毒感染免疫预防母婴传播的效果评估[J].中华医院感染学杂志,2015,25(7):1657-1659.
[11]杨桂桂,尹龙德.乙型肝炎母婴传播阻断效果调查分析[J].河南预防医学杂志,2013,24(6):438-439.
[12]Delorme-Axford E,Sadovsky Y,Coyne CB.The placenta as a barrier to viral infections[J].Annu Rev V,2014,1(1):133-146.
[13]Walker TY,Smith EA,Fenlon N,et al.Characteristics of pregnant women with hepatitis B virus infection in 5 US public health jurisdictions,2008-2012[J].Public Health Rep,2016,131(5):685-694.
[14]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.
[15]Zhang L,Gui X,Fan J,et al.Breast feeding and immunoprophylaxis efficacy of mother-to-child transmission of hepatitis B virus[J].J Matern Fetal Neonatal Med,2014,27(2):182-186.
[16]Pinto M,Dawar M,Krajden M,et al.Will infant hepatitis B vaccination protect into adulthood?Extended Canadian experience after a 2,4,6 month immunization schedule[J].Pediatr Infect Dis J,2017,883-885.
[17]罗灿,汤柳英,王雄虎,等.乙型肝炎病毒母婴传播影响因素的研究进展[J].中国妇幼卫生杂志,2016,7(1):72-75.
[18]Dini G,Toletone A,Barberis I,et al.Persistence of protective antiHBs antibody levels and anamnestic response to HBV booster vaccination:a cross-sectional study among healthcare students 20 years following the universal immunization campaign in Italy[J].Hum Vaccin Immunother,2017,13(2):440-444.
[19]陈旭,陈洁.乙型肝炎病毒母婴传播及其预防的研究进展[J].现代妇产科进展,2014,23(10):844-848.
[20]唐洁,许联红,陈洁,等.新生儿免疫预防乙型肝炎病毒母婴传播的效果及传播易患因素分析[J].中国妇幼保健,2014,29(21):3427-3430.