母源性抗乙型肝炎病毒表面抗原抗体对婴儿乙型肝炎疫苗接种的影响  

Inhibition of maternal antibody to hepatitis B surface antigen on antibody response to hepatitis B vaccine in infants

作　　者：胡娅莉[1] 武巧珍[1] 耿全林[2] 陈宏[1] 王志群[1] 周镇先[2] 李瑛[3] 周乙华[1] 

机构地区：[1]南京大学医学院附属鼓楼医院妇产科,210008 [2]南京市第二医院 [3]江苏省计划生育科学技术研究所

出　　处：《中华围产医学杂志》2010年第3期181-186,共6页Chinese Journal of Perinatal Medicine

基　　金：江苏省医学领军人才项目（LJ200628）、江苏省母胎医学重点学科建设项目（XK200709）、江苏省生殖健康公共技术服务中心（BM2008151）,南京市医学发展重点项目（ZKM06050,ZKX06018）

摘　　要：目的了解母源性抗乙型肝炎病毒表面抗原抗体（anti—hepatitis B surface antigen antibody，抗HBs抗体）对婴儿乙型肝炎疫苗接种后抗体应答的影响。方法2006年10月至2007年1月在南京大学医学院附属鼓楼医院产前检查并住院分娩的单胎足月妊娠妇女中，选择抗-HBs抗体阳性孕妇43例（阳性组）和阴性孕妇29例（阴性组），其足月儿出生时和出生后1个月分别接种乙型肝炎疫苗。定量检测孕妇分娩前、脐动脉血及婴儿1月龄和3．5月龄的抗HBs抗体水平。结果阳性组43例新生儿脐血抗-HBs抗体也为阳性，与母血清抗体水平的相关系数r=0．98（t=39．05，P〈0．01）；1月龄时，42例抗体仍阳性。阴性组29例新生儿脐血和1月龄时抗HBs抗体均阴性。3．5月龄时，两组抗-HBs抗体阳性率均为100％，但阴性组平均抗-HBs抗体浓度高于阳性组[（466．9±86．7）mIU／ml和（151．2±23．1）mIU／ml，t=2．72，P=0．011]。母源性抗-HBs抗体〉1000mIU／ml的5例婴儿中，3例在接种2次疫苗后没有产生主动抗体应答。结论母源性抗-HBs抗体可抑制乙型肝炎疫苗前2次接种后的抗体应答。Objective To investigate whether maternal antibody to hepatitis B surface antigen （anti-HBs） in infants may interfere with the antibody response to hepatitis B vaccine. Methods Infants from singleton pregnant mothers, who delivered at full term at the Affiliated Drum Tower Hospital of Nanjing University Medical School from October 2006 to January 2007, were divided into two groups based on their mothers＇ status of anti HBs （43 positive and 29 negative）. All infants were vaccinated with hepatitis B vaccine at birth and one month thereafter. Serum anti HBs were quantitatively determined for the mothers before delivery and for infants in cord blood at delivery and in serum at the age of 1 and 3.5 months. Results Anti-HBs of all 43 newborns in the positive group were positive in cord blood with the coefficiency of 0.98 to the maternal serum anti-HBs level （t= 39. 05,P〈0. 01）. Forty-two out of the 43 infants remained anti-HBs positive at the age of 1 month. Anti-HBs was negative both at birth and 1 month old in infants of the negative group. However, all infants in both groups were anti HBs positive at 3.5 months of age, while the average concentration of anti-HBs in infants of the negative group was significantly higher than that of the positive group [（466.9±86. 7） mlU/ml vs （151. 2±23. 1） mIU/ml, t=2.72, P=0.011]. Among the 5 infants whose maternal anti-HBs level 〉1000 mlU/ml, 3 did not produce active antibodies against two doses of hepatitis B vaccination. Conclusions Passively acquired maternal anti-HBs in infants can inhibit the active antibody response to hepatitis B vaccine, and the extent of this effect is associated with maternal anti HBs level.

关 键 词：肝炎表面抗原 乙型 肝炎疫苗 乙型 接种 婴儿 新生 

分 类 号：R1[医药卫生—公共卫生与预防医学]