乙型肝炎表面抗原阳性母亲所产婴儿对乙型肝炎疫苗无或低应答的影响因素  

The influence factors of non-responsiveness and low-responsiveness to hepatitis B vaccine of infants born to hepatitis B surface antigen positive mothers

作　　者：郭健[1] 高怡[1] 王素萍[1] 郭珍[1] 张临瑞[1] 汪波[2] 

机构地区：[1]山西医科大学流行病学教研室,太原030001 [2]太原市第三人民医院妇产科

出　　处：《中华传染病杂志》2014年第8期460-463,共4页Chinese Journal of Infectious Diseases

基　　金：国家自然科学基金资助项目（81072341）;山西省留学人员科研基金资助项目（2008-50）

摘　　要：目的 探讨HBsAg阳性母亲所产婴儿对乙型肝炎疫苗免疫无或低应答的影响因素.方法 选择2011年7月至2012年12月太原市第三人民医院妇产科HBsAg阳性母亲及其足月分娩的新生儿219对.检测母亲及新生儿HBsAg、抗-HBs、HBeAg和HBV DNA水平,并对新生儿随访12个月,观察HBV宫内传播、新生儿HBeAg状态、性别、分娩方式、喂养方式以及随访期间是否患感染性疾病对乙型肝炎疫苗免疫应答的影响.单因素分析采用卡方检验,多因素分析采用非条件Logistic回归模型.结果 219名婴儿中,16名对乙型肝炎疫苗免疫无应答,33名对乙型肝炎疫苗免疫低应答,无或低应答率为22.37％.单因素分析发现,新生儿HBeAg阳性（x2=4.895,P=0.027）、阴道产（x2=5.210,P=0.022）、随访期婴儿患感染性疾病（x2=4.329,P=0.037）均与乙型肝炎疫苗免疫无或低应答有关.以母亲HBeAg状态进行分层分析,未发现所产婴儿出生时HBeAg状态与疫苗免疫应答水平存在关联.多因素分析发现,阴道产（OR=2.022,95％CI：1.045～3.914）和婴儿患感染性疾病（OR=2.324,95％CI：1.058～5.103）与乙型肝炎疫苗免疫无或低应答相关.结论 HBsAg阳性母亲所产婴儿经阴道分娩或随访期罹患感染性疾病时,易发生乙型肝炎疫苗免疫无或低应答.Objective To investigate the influence factors of non-responsiveness and lowresponsiveness to hepatitis B vaccine of infants born to hepatitis 1 surface antigen （HBsAg） positive mothers.Methods A total of 219 HBsAg positive mothers and their full-term neonates were selected from July 2011 to December 2012 in the Third People＇s Hospital of Taiyuan.Serologic hepatitis B virus （HBV） markers and HBV DNA load of mothers and their neonates were determined.Neonates were followed up for 12 months to observe the effect of HBV intrauterine infection,hepatitis B e antigen （HBeAg） status,sex,delivery mode,feeding option and suffering from infectious disease during followup period on the immune response to hepatitis B vaccine.Chi-square test was used in univariate analyses and unconditional Logistical regression was used in multivariate analyses.Results There were 16 cases of non-responsiveness and 33 cases of low-responsiveness in all 219 neonates.The rate of non-responsiveness and low-responsiveness was 22.37 %.In univariate analyses,neonatal HBeAg positivity （x2 =4.895,P=0.027）,natural birth （x2 =5.210,P=0.022）,suffering from infectious diseases during follow-up period （x2 =4.329,P=0.037） were significantly associated with non-responsiveness and low-responsiveness.There was no relationship between mother HBeAg positivity and the level of response to hepatitis B vaccine.In multivariate analyses,natural birth （OR=2.022,95 %CI：1.045-3.914） and suffering from infectious diseases （OR=2.324,95 % CI：1.058-5.103） were associated with non-responsiveness and low-responsiveness.Conclusion Infants born to HBsAg positive mothers with natural birth or suffering from infectious diseases during follow-up period are more likely to be non-responsiveness and lowresponsiveness to hepatitis B vaccine.

关 键 词：肝炎疫苗 乙型 婴儿 宫内传播 

分 类 号：R512.62[医药卫生—内科学]