不同免疫方式阻断乙型肝炎病毒母婴水平传播  

Blocking of Mother-to-infant Horizontal Transmission of Hepatitis B Virus by Different Immunization Strategies

作　　者：陈红[1] 刘向梅[1] 韩静[1] 

机构地区：[1]北京市海淀区妇幼保健院,100080

出　　处：《中国预防医学杂志》2009年第6期475-478,共4页Chinese Preventive Medicine

基　　金：北京市卫生局妇幼科研基金资助项目(C03011403)

摘　　要：目的探讨主动免疫和主动加被动联合免疫的不同方式阻断乙型肝炎(乙肝)病毒(HBV)母婴水平传播的效果,以及乙肝表面抗体HBsAb的产生情况。方法对在北京市海淀区妇幼保健院分娩的母亲乙肝病毒携带者的婴儿作为观察对象。这些婴儿生后24h内抽取外周静脉血检测HBV抗原HBsAg、HBeAg及HBV表面抗体(HBsAb)均为阴性,HBV抗体乙肝e抗体(HBeAb)和乙肝核心抗体(HBcAb)均为阳性。所有观察对象均采用基因重组乙肝疫苗(HBVac)按0、1、6月各10μg方案接种,随机分为观察1组和观察2组,观察1组232例婴儿生后24h内注射(蓉生)乙肝免疫球蛋白(HBIG)100～200IU,生后15～30d重复1次;观察2组182例婴儿生后不注射HBIG。观察项目:①观察生后3个月、6个月、1岁时HBsAg和HBeAg阳性率。②观察生后3个月、6个月和1岁时HBsAb定性阳性率和1岁时HBsAb定量。③观察生后3个月、6个月、1岁时HBeAb和HBcAb阴性率。结果①所有观察对象生后3个月、6个月、1岁时HBsAg和HBeAg检测均为阴性。②生后3个月观察1组HBsAb阳性率96.53%;观察2组HBsAb阳性率为75.68%,两组经统计学处理,差异有统计学意义(χ2=26.294,P=0.000)。生后6个月观察1组HBsAb阳性率为88.24%;观察2组HBsAb阳性率为96.36%两组差异有统计学意义(χ2=5.215,P=0.022)。生后1岁时观察1组HBsAb阳性率为93.53%;观察2组HBsAb阳性率为97.80%,两组差异有统计学意义(χ2=4.242,P=0.039)。③观察生后3个月、6个月、1岁时HBeAb、HBcAb阴转率和1岁时HBsAb定量检测结果,所有结果观察2组均高于观察1组,但除了生后3个月观察2组HBeAb阴转率大于观察1组,差异有统计学意义外,其他指标差异均无统计学意义。结论国产(汉逊)酵母基因重组HBVac10μg0、1、6方案单纯主动免疫可使母亲HBsAg携带者的婴儿产生不低于加用HBIG联合免疫的免疫效应。HBIG对婴儿自身主动产生保护性抗体HBsAb存在一定程度的抑制现象。Objective To explore the blocking effect of active immunization and combined active and passive immunization on mother - to - infant horizontal transmission of hepatitis B virus, and to study the situation of HBsAb formation. Methods Infants whose mothers were HBsAg positive were observed. The HBsAg, HBeAg and HBsAb were all negative and HBeAb, HbcAb were all positive in vein blood of the infants within 24 h after birth. All infants were inoculated with 10μg of hepatitis B virus vaccine at 0, 1, 6 month after birth. The infants were randomly divided into group 1 and group 2. An additional injection of 100 -200 IU of hepatitis B immunoglobulin was given to infants of group 1 within 24 h and at 15 -30 d after birth, compared with group 2. Positive rates of HBsAg, HBeAg were observed at 3, 6 month and 1 year after birth. Qualitative determination of HBsAb at 3, 6 month after birth and quantitative determination of HBsAb at 1 year after birth were conducted. Also negative rates of HBeAb, HBcAb were observed at 3, 6 month and 1 year after birth. Results①All infants were HBsAg and HBeAg negative at 3, 6 month and 1 year after birth. ②Positive rates of HBsAb at 3, 6 month and 1 year after birth were 96. 53%, 88. 24%, 93.53% for group 1, and 75. 68%, 96. 36%, 97. 80% for group 2, respectively, and the differences between the two groups were statistically significant （ x^2 = 25. 294, P 〈 0. 001 ; x^2 = 5. 215, P = 0. 022 ; x^2 = 4. 242, P = 0. 039）. ③Negatire conversion rates of HBeAb, HbcAb and HBsAb levels were statistically higher in group 2 than in group 1 at 3 month after birth. Conclusion Active immunization with recombined HBV vaccine had equal effects to combined active and passive immunization in infants. HBIG has some inhibition effect on protective HBsAb release by infants.

关 键 词：乙型肝炎病毒 免疫方式 水平传播 母婴 抗原 抗体 

分 类 号：R512.62[医药卫生—内科学] R186[医药卫生—临床医学]