乙型肝炎高效价免疫球蛋白联合乙型肝炎疫苗免疫母亲和婴幼儿的随访研究  

A follow-up study on the efficacy of hepatitis B immanoglobulin combining hepatitis B vaccine in infants born to HBsAg positive mothers

作　　者：王琰[1] 闫永平[1] 张云 门可[1] 苏海霞[1] 李端[1] 徐德忠[1] 张惠琴 李军 

机构地区：[1]第四军医大学预防医学系流行病学教研室,西安710032 [2]劳动卫生与环境卫生教研室 [3]陕西省妇幼保健医院产科

出　　处：《中华流行病学杂志》2007年第6期550-554,共5页Chinese Journal of Epidemiology

基　　金：国家自然科学基金资助项目（30230320）

摘　　要：目的探讨乙型肝炎（乙肝）病毒（HBV）表面抗原（HBsAg）阳性母亲所产婴幼儿经乙肝高效价免疫球蛋白（HBIG）和乙肝疫苗联合免疫后的免疫效果。方法对184例HBsAg阳性母亲所产婴幼儿进行随访调查，于婴幼儿7、24、36月龄应用酶联免疫吸附试验检测血清HBV主要标志物。结果184例婴幼儿出生时HBsAg阳性者7例，HBV宫内感染率为3．80％（7／184）。分娩时HBsAg、HBeAg双阳性母亲所产婴幼儿HBV宫内感染率为11．63％（5／43）；而单阳性母亲感染率约为1．42％（2／141）。7月龄随访到125例婴幼儿，24、36月龄随访到108例婴幼儿，仅2例出生于双阳性母亲的婴幼儿HBsAg仍持续阳性，其余在7月龄随访时均已阴转，HBV慢性感染率为28．57％。婴幼儿出生时抗-HBs阳性率为7．02％，经HBIG和乙肝疫苗联合免疫，7月龄时抗-HBs阳性率达92％，24月龄降为72．04％。而婴幼儿抗-HBs产生与母亲双阳性无关，与其出生时HBsAg阳性呈显著相关。双阳性39例母亲所产婴幼儿出生时25例HBeAg阳性，随访时除2例HBsAg为阳性的婴幼儿HBeAg仍持续阳性外，余均转阴。随访中未见婴幼儿出现HBsAg或HBeAg阳转。结论HBsAg阳性母亲所产婴幼儿经HBIG和乙肝疫苗联合免疫后免疫效果良好，母亲双阳性可能并不影响婴幼儿联合免疫后抗-HBs的产生。Objective To study the efficacy of hepatitis 13 immunoglobulin （HBIG） combining hepatitis 13 vaccine in high risk infants born to HBsAg positive mothers through a follow-up study program. Methods 184 infants （4 twin pairs） born to HBsAg carrier mothers who were consecutively recruited from December 2002 to August 2004 were followed. Major H13V serologic markers in all infants were detected by enzyme-linked immunosorbent assay （ELISA） when they were at birth, at 7^th, at 24^th and at 36^th months. Results 7 of the 184 infants were HBsAg positive at birth, making the transplacental intrauterine infection rate of HBV as 3.80% （7/184）. 125 infants were followed up at 7^th months and 108 infants were followed up at 24^th and 36^th months. Only 2 of the 7 infants born to HBsAg-positive and HBeAg-positive mothers were persistently sera positive for HBsAg, making the chronic infection rate of HBV as 28.57 %. The other 140 infants were HBsAg negative during the follow-up period. The rate of detectable anti-HBs in infants was 7.02 % at birth. After infants were immunized by HBIG combining hepatitis 13 vaccine, the anti-HBs- positive rate reached 92 % at Th months, and gradually descended thereafter. 72.04 % of the infants at 24th and 60 % at 36^th months showed detectable levels of anti-HBs. There was significant correlation between the produce of anti-HBs in infants and HBsAg-positive at birth while HBsAg-positive and HBeAg-positive in mothers did not relate to the produce of anti-HBs in their infants. Of 39 infants born to HBsAg-positive and HBeAg-positive mothers, 25 showed detectable levels of H13eAg. During the follow-up peirod, HBeAg was still detectable in 2 infants who were also HBsAg positive and the others all became HBeAg-negative but no infant became HBeAg-positive. Conclusion The efficacy of HBIG combining hepatitis B vaccine in high risk infants was fine.

关 键 词：乙型肝炎病毒 乙肝高效价免疫球蛋白 乙型肝炎疫苗 随访研究 宫内感染 

分 类 号：R686[医药卫生—骨科学]