乙型病毒性肝炎母婴传播阻断效果观察及病毒基因序列特征分析  

Observation of immunoprophylactic effects of hepatitis B vaccine against mother-to-infant transmissions of hepatitis B virus and analysis of characteristics of viral gene sequences

作　　者：尹文娇[1] 沈立萍[1] 王富珍[2] 张国民[2] 郑徽[2] 安婧[3] 杜飞[4] 王锋[1] 刘铁柱[1] 孟庆玲[1] 伊瑶[1] 崔富强[2] 毕胜利[1] 

机构地区：[1]中国疾病预防控制中心病毒病预防控制所,国家卫生和计划生育委员会医学病毒学和病毒病重点实验室,北京102206 [2]中国疾病预防控制中心免疫规划中心,北京100050 [3]甘肃省疾病预防控制中心,甘肃兰州730000 [4]四川省疾病预防控制中心,四川成都610041

出　　处：《中国疫苗和免疫》2017年第2期138-143,共6页Chinese Journal of Vaccines and Immunization

基　　金：国家“十二五”科学技术艾滋病和病毒性肝炎等重大传染病防治重大专项乙型肝炎病毒免疫预防新策略的研究课题(编号:2012ZX10002001)

摘　　要：目的观察乙型病毒性肝炎(乙肝)母婴传播阻断效果;探讨母婴传播阻断失败的病毒学因素。方法在四川和甘肃省5家医院招募439名慢性乙肝病毒(Hepatitis B virus,HBV)感染孕妇及其新生儿,开展调查并采集血标本。对新生儿接种全程3剂次乙肝疫苗(Hepatitis B vaccine,HepB),检测母婴HBV血清学标志物和母亲病毒载量,扩增母亲HBV基因序列。结果研究地区乙肝母婴传播阻断成功率为93.39%,失败率为2.73%,无应答率为3.87%。母亲HBV基因型为C(43.01%)、B(37.63%)和D(19.35%);血清型为adr(37.63%)、adw(36.56%)、ayw(21.51%)、不确定型别(3.23%)和ayr(1.08%);阻断成功组和失败组的母亲a抗原决定簇突变率分别为30.59%、25.00%;阻断成功组与失败组的母亲HBV基因型构成、血清型构成以及a抗原决定簇突变率均无显著性差异(Fisher’s精确概率法,P>0.05)。结论研究地区乙肝母婴传播阻断成功率较高。HBV基因型、血清型差异以及a抗原决定簇突变不是影响母婴传播阻断失败的因素。Objective To observe the immunoprophylactic effects of hepatitis B vaccine （HepB） against mother-to-infant transmissions of hepatitis B virus （ HBV）, and describe viral factors of immunoprophy-lactic failure. Methods We recruited 439 pregnant women with chronic HBV infection and their infants from 5 hospitals of Sichuan and Gansu provinces to conduct a questionnaire survey and collect blood samples. Infants had been vaccinated with 3 doses of HepB. We measured maternal and infant HBV serological markers and the HBV DNA loads of mothers. Maternal HBV gene sequences were amplified. Results The immunoprophylactie success, failure, and unresponsiveness rates of HBV mother-to-infant transmissions in the study settings were 93.39%, 2.73%, and 3.87%, respectively. The HBV geno-types from mothers were C （43.01%）, B （37.63%）,and D （19.35%）, and the HBV Serotypes from mothers were adr （37.63%）, adw （36.56%）, ayw （21.51%）, uncertain type （3.23%）, and ayr （1.08%）. The mutation rate of the HBV ‘a＇ determinant in mothers was 30. 59% for the immunoprophylactic success group and 25.00% for the failure group. There was no significant difference in genotype proportion, serotype proportion, or ‘a ＇ determinant mutation rate of mothers＇ HBV between the success group and the P 〉 0.05 ）. Conclusions The immunoprophylactic success rate of in these study settings was high. HBV genotypes, serotypes, and ‘a＇ determinant mutations were not associated with immunoprophylactic failure.

关 键 词：乙型病毒性肝炎 母婴传播 阻断失败 “a”决定簇突变 

分 类 号：R186[医药卫生—流行病学] R512.62[医药卫生—公共卫生与预防医学]