山东省儿童突破性乙型肝炎病毒感染发生率及原因初步分析  

Preliminary analysis on the prevalence and causes of breakthrough hepatitis B virus infection among children in Shandong province, China

作　　者：张丽[1] 颜丙玉[1] 李漫时[1] 宋立志[1] 吕静静[1] 许青[1] 徐爱强[2] 

机构地区：[1]山东省疾病预防控制中心免疫预防管理所山东大学预防医学研究院山东省传染病预防控制重点实验室,济南250014 [2]山东省疾病预防控制中心山东大学预防医学研究院山东省传染病预防控制重点实验室

出　　处：《中华预防医学杂志》2013年第10期933-939,共7页Chinese Journal of Preventive Medicine

基　　金：国家＂十二五＂科技重大专项（2012ZX10002001）;山东省医药卫生重点项目（2011HD006）

摘　　要：目的 了解山东省新生儿普种乙肝疫苗以来儿童中突破性乙肝病毒（hepatitis B virus,HBV）感染发生率及可能原因.方法 选取2006年山东省乙肝血清学调查中1～15岁（1992-2005年出生）且明确完成3剂次及以上乙肝疫苗免疫的儿童作为研究对象,共3527名.对所有研究对象进行问卷调查,同时采集静脉血标本,检测乙肝病毒表面抗原（hepatitis B surface antigen,HBsAg）、乙肝病毒表面抗体（antibody against HBsAg,Anti-HBs）和乙肝病毒核心抗体（antibody against hepatitis Bcore antigen,Anti-HBc）；对其中HBsAg阳性儿童的父母进行随访,采集其静脉血标本检测HBsAg.采用logistic回归分析突破性HBV感染、突破性慢性HBV感染的相关因素.结果 3527名研究对象总体突破性HBV感染率为3.15％ （111/3527）,随出生年份的后移而呈下降趋势（Х^2趋势=44.83,P＜0.01）,其中1992年出生儿童最高（9.9％,16/161）,2000年最低（0.8％,2/258）；自述父、母亲及其他家庭成员HBsAg阳性者（15.22％,7/46、34.09％,15/44、17.65％,6/34）均高于阴性者（2.99％,104/3481、2.76％,96/3483、3.01％,105/3493）（Х^2值分别22.28、13.97、23.68,P值均＜0.01）；首针接种不及时者（5.37％,41/763）高于及时者（2.53％,70/2764）（Х^2=15.60,P值均＜0.01）.突破性慢性HBV感染率为1.08％ （38/3527）,随出生年份的后移而呈下降趋势（Х^2趋势=9.96,P＜0.01）,其中1992年出生儿童最高,为3.1％ （5/161）,1997年出生儿童最低,为0.4％（1/261）；自述父、母亲及其他家庭成员HBsAg阳性者（13.04％,6/46、29.55％,13/44、17.65％,6/34）均高于阴性者（0.92％,32/3481、0.72％,25/3483、0.92％,32/3493）（Х^2值分别62.62、338.80、88.44,P值均＜0.05）；首针接种不及时者（1.83％,14/763）高于及时者（0.87％,24/2764）,差异均有统计学意义（Х^2=5.16,P=0.02）.多因素分析显示,自述父、母亲HBsAg阳性者突破性HBV感染风险高于�Objective To know the prevalence and probable causes of breakthrough hepatitis B virus （HBV） infection among children born after the introduction of universal infant hepatitis B vaccination in Shandong province,China.Methods The subjects of this study were selected from the provincial hepatitis B serosurvey conducted in 2006,who were born between 1992 and 2005 （aged 1-15 years） and were confirmed to have completed three or more doses of hepatitis B vaccine.Finally 3527 subjects were involved in this study and were investigated using a unified questionare.Blood samples were collected from them to detect hepatitis B surface antigen （HBsAg）,antibody against HBsAg （Anti-HBs） and antibody against hepatitis B core antigen （Anti-HBc）.The parents of children positive for HBsAg were followed up.Blood samples were collected from their parents to detect for HBsAg.The rate and correlative factors of breakthrough HBV infection were gotten by single-factor and multiple-factor analysis.Results For the 3527 subjects,the overall prevalence rates of breakthrough HBV infection were 3.15% （111/3527）,which decreased while birth year grew（Х^2Trend =44.83,P 〈 0.01）,the rate of subjects born in 1992 was the highest （9.9%,16/161）,subjects bornd in 2000 was the least （0.8%,2/258）,the rate of the self-report positive HBsAg status of mother,father and the other family members（15.22%,7/46;34.09%,15/44; 17.65%,6/34） were higher thau the negative （2.99%,104/3481,2.76%,96/3483,3.01%,105/3493） （Х^2 values were 22.28,13.97,23.68,respectively,all P values were 〈 0.01）,timely first dose of hepatitis B vaccine （5.37%,41/763） was higher than the subjects that not in time （2.53%,70/2764） （Х^2 =15.596,P 〈0.01）.The overall prevalence rates of breakthrough chronic HBV infection was 1.08% （38/3527）,which decreased while birth year grew （Х^2Trend =9.96,P 〈 0.05）,the rate of subjects born in 1992 was the most （3.1%,5/161）,subjects born in 1997 was the least （0.4%,1/261）,

关 键 词：儿童 肝炎疫苗 乙型 肝炎病毒 乙型 突破性感染 危险因素 

分 类 号：R725.1[医药卫生—儿科]