HBV母婴传播阻断效果及影响因素分析  

Blocking effects on and influencing factors for mother-to-infant transmission of hepatitis B virus: a study in Changchun,China

作　　者：王川[1] 武兴[1] 王崇[2] 孔菲[2] 尤丽丽[1] 马平[3] 李杰[4] 牛俊奇[2] 姜晶[1] 

机构地区：[1]吉林大学第一医院临床流行病学研究中心,长春130021 [2]吉林大学第一医院肝胆胰内科,长春130021 [3]长春市卫生局,长春130022 [4]北京大学医学部病原生物学系,北京100191

出　　处：《临床肝胆病杂志》2015年第8期1238-1243,共6页Journal of Clinical Hepatology

基　　金：十二.五国家科技重大专项课题子课题(2012ZX10002001-001)

摘　　要：目的评价应用不同剂量乙型肝炎疫苗(Hep B)联合乙型肝炎免疫球蛋白(HBIG)阻断HBV母婴传播的效果及HBV母婴传播的影响因素。方法选取2012年7月-2015年2月在吉林大学第一医院进行HBV母婴阻断的785对乙型肝炎孕妇及其新生儿作为研究对象,根据孕妇产前HBV血清学标志物检查结果,对HBs Ag单阳性、HBs Ag与HBe Ag双阳性母亲的新生儿制订不同剂量阻断方案,在出生后2 h内分别注射10μg或20μg Hep B联合100 IU HBIG,并于1、6月龄继续接种Hep B。对入组孕妇及婴儿进行长期随访,采集婴儿7和12月龄静脉血检测HBV血清学标志物。计数资料组间比较采用χ2检验或Fisher确切概率法,组间HBV DVA的比较经对数转换后采用Mann-Whitney U秩和检验。探讨HBV相关因素采用非条件Logistic回归分析,并做影响HBV母婴传播的多因素分析。结果 785例新生儿中,HBs Ag阳性但HBe Ag阴性的529名孕妇所生的新生婴儿无一感染,阻断成功率为100%;256例HBs Ag与HBe Ag双阳性孕妇所生新生儿中,有14例婴儿感染,阻断成功率为94.53%。母亲HBe Ag阳性、HBV DNA>108IU/ml与阻断失败密切相关(P<0.001)。本研究未发现母亲的分娩方式、新生儿喂养方式等因素与阻断失败有关。探讨干预依从性时发现,首针疫苗未得到及时足量注射的新生儿更易发生感染。进一步Logistic回归分析发现,母亲HBV DNA>108IU/ml、首针疫苗未及时或未足量接种及男性婴儿更易发生HBV母婴传播。结论 HBs Ag阳性母亲的新生儿经过联合免疫后,可有效提高HBV母婴阻断成功率。母亲的感染状态、病毒载量和首针疫苗注射情况是影响HBV母婴传播阻断成功与否的决定性因素。Objective To study the blocking effects of different concentrations of hepatitis B vaccine（ Hep B） combined with hepatitis B immune globulin（ HBIG） on mother- to- infant transmission of hepatitis B virus（ HBV） and the influencing factors for mother- to- infant transmission of HBV. Methods A total of 785 pregnant women with hepatitis B and their infants who received interruption of mother- to-infant transmission of HBV in our hospital from July 2012 to February 2015 were enrolled as subjects. According to the results of prenatal examination of serum HBV markers in pregnant women,blocking regimens with different doses were made for infants born to HBs Ag- positive /HBe Ag- negative and HBs Ag- positive / HBe Ag- positive mothers,who received 10 μg and 20 μg Hep B,respectively,combined with 100 IU HBIG by injection within 2 hours after birth,and were vaccinated with Hep B again at 1 and 6 months after birth. A long- term follow-up was performed in pregnant women and infants,and the venous blood of infants was collected at 7 and 12 months after birth for evaluation of serum HBV markers. Results In the 785 infants,none of the infants born to the 529 HBs Ag- positive / HBe Ag- negative mothers were infected,suggesting a blocking rate of 100%,while 14 out of 256 infants born to HBs Ag- positive / HBe Ag- positive mothers were infected,yielding a blocking rate of 94. 53%. The positive HBe Ag and a HBV DNA level higher than 108 IU / ml were significantly correlated with blocking failure（ P 0. 001）,while other factors including childbirth and feeding methods were not found correlated with blocking failure in this study. The investigation of intervention for compliance revealed that infants who were not given timely or full- dose injection for the first vaccination were more likely to be infected. Further logistic regression analysis showed that the incidence of mother- to- infant transmission of HBV was higher in infants born to mothers with a HBV DNA level higher than 108 IU / ml,infants who were not giv

关 键 词：肝炎病毒 乙型 疾病传播 垂直 免疫接种 加强 

分 类 号：R714.251[医药卫生—妇产科学]