HBsAg阳性母亲新生儿乙肝疫苗应答的影响因素研究  

Influencing factors of hepatitis Bvaccine response in newborns of HBsAg positive mothers

作　　者：陈霞[1] 王玉平[1] CHEN Xia;WANG Yu-ping(Department of Obstetrics and Gynecology,Lianyungang Municipal Oriental Hospital,Jiangsu Lianyungang 222002,China)

机构地区：[1]连云港市东方医院妇产科,江苏连云港222002

出　　处：《中国妇幼健康研究》2018年第8期958-961,共4页Chinese Journal of Woman and Child Health Research

基　　金：连云港市卫生局科研资助项目(1328)

摘　　要：目的分析HBsAg阳性母亲新生儿乙肝疫苗应答的影响因素。方法选取于2015年1月至2016年12月在连云港市东方医院就诊的HBsAg阳性孕产妇及其足月新生儿100对,根据我国疫苗接种程序,要求新生儿接种乙肝疫苗并随访至12月龄,检测孕产妇、新生儿出生24h和12月龄时的外周血HBV血清标志物、Toll样受体3(TLR3)蛋白表达量和免疫细胞水平。结果新生儿HBV血清标志物以"HBsAg^+""HBsAg^+、HBeAg^+、抗-HBe^+""HBeAg^+、抗-HBe^+"和"HBV血清标志物全阴"为主,这四种模式下,抗-HBs水平比较差异有统计学意义(F=8.807,P=0.003),新生儿乙肝疫苗无应答率为20.22%,弱应答率为6.74%,强应答率为73.03%,各应答率四种模式间比较差异有统计学意义(H=6.782,P<0.05),其中强应答率高于无应答率和弱应答率(χ~2值分别为4.467、8.591,均P<0.05);四种模式下新生儿外周血CD_4^+T淋巴细胞高于CD_8^+T淋巴细胞,组间比较差异有统计学意义(t值分别为6.692、5.047、8.937、10.563,均P<0.05)。结论 HBsAg阳性孕产妇的HBV血清学模式与新生儿的HBV血清学模式相关,血清学模式为"HBeAg^+、抗-HBe^+"的新生儿乙肝疫苗无/弱应答率较低。Objective To analyze the influencing factors of hepatitis Bvaccine response in newborns of HBsAg positive mothers.Methods From January 2015 to December 2016,100 pairs of HBsAg positive pregnant women and their full-term newborns were selected in Lianyungang Municipal Oriental Hospital.According to the vaccination program in China,neonates were required to receive hepatitis B vaccination and followed up to the age of 12 months.Serum HBV markers,TLR3 protein expression and the level of immune cells in peripheral blood of pregnant women,newborns 24 hours after birth and infants at the age of 12 months were detected respectively.Results Four types of common neonatal modes of HBVM appeared as HBsAg~＋,HBsAg~＋-HBeAg~＋anti-HBe~＋,HBeAg~＋anti-HBe~＋and HBVM-,respectively.Among four models,there was significant difference in anti-HBs levels（F=8.807,P=0.003）.Non-response rate was 20.22%,weak response rate was 6.74%,and strong response rate was73.03%.The response rate was significantly different among models（H =6.782,P〈0.05）,and the strong response rate was higher than non-response rate and weak response rate（χ~2 value was 4.467 and 8.591,respectively,both P〈0.05）.The CD4~＋T cells in neonatal peripheral blood were higher than CD8~＋T lymphocytes,and the differences between groups were statistically significant（t value was 6.692,5.047,8.937 and 10.563,respectively,all P〈0.05）.Conclusion HBV serological pattern of HBsAg positive pregnant women is associated with the HBV modes of neonates.Neonates with the model of HBeAg~＋anti-HBe~＋show a lower non-response/weak response rate on hepatitis B vaccine.

关 键 词：乙型肝炎病毒 乙肝疫苗免疫应答 免疫细胞数量 HBV血清标志物 

分 类 号：R172[医药卫生—妇幼卫生保健]