乙肝母婴传播类型与乙肝疫苗免疫效果的关系  

Relationship between types of mother-to-infant HBV transmission and efficacy of HBV vaccine

作　　者：蔡倩莹 陆红梅[2] 孙晓冬[3] 郑英杰 CAI Qian-ying;LU Hong-mei;SUN Xiao-dong;ZHENG Ying-jie(Department of Epidemiology,School of Public Health,Fudan University ,Shanghai 200032,China;Department of Immunization Prevention and Planning,Songjiang Center for Disease Control and Prevention,Shanghai 201620,China;Institute of Immunization Prevention and Planning,Shanghai Center for Disease Control and Prevention,Shanghai 200336,China;Key Laboratory for Public Health Safety,Ministry of Education-School of Public Health,Fudan University,Shanghai 200032,China;Key Laboratory for Health Technology Assessment,National Commission of Health and Family Planning,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学公共卫生学院流行病学教研室,上海200032 [2]上海市松江区疾病预防控制中心免疫预防科,上海201620 [3]上海市疾病预防控制中心免疫规划所,上海200336 [4]复旦大学教育部公共卫生安全重点实验室,上海200032 [5]复旦大学国家卫生和计划生育委员会卫生技术评估重点实验室,上海200032

出　　处：《上海预防医学》2019年第4期276-289,共14页Shanghai Journal of Preventive Medicine

基　　金：国家自然基金项目(81373065;81773490);国家重点研发计划项目"生物安全重点技术研发"重点专项(2017YFC1200203);上海市教育委员会科研创新重点项目(14ZZ015)

摘　　要：持续性乙型肝炎病毒(hepatitis B virus,HBV)感染分为两类:乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)阳性(显性HBV感染)和阴性(隐匿性HBV感染,occult hepatitis B infection,OBI)。对显性感染的认识相对清楚,但对OBI的认识仍然有限。本文重点介绍OBI的危害及其流行情况,并分别阐述了母婴不同乙肝传播类型与乙肝疫苗免疫效果的关系。HBV以母婴传播为主,两类HBV感染在母婴传播上表现为四种类型:(Ⅰ)母亲HBV显性-子代HBV显性;(Ⅱ)母亲HBV显性-子代OBI;(Ⅲ)母亲OBI-子代OBI;(Ⅳ)母亲OBI-子代HBV显性。HBV疫苗免疫后时代可能以Ⅱ型传播为主。应加强对OBI的研究,重新评估现有HBV免疫策略对HBV母婴传播的影响。Persistent hepatitis B virus(HBV) infection can be classified into two categories:HBsAg-positive(overt HBV infection,overt-HBI) and HBsAg negative(occult hepatitis B infection,OBI).The understanding of overt-HBI is relatively clear;however,the knowledge of OBI remains limited.Mother-to-infant transmission is the main route of HBV transmission.Considering the existence of OBI,HBV transmission from mother to infant are composed of four types,(Ⅰ) overt-HBI to overt-HBI,(Ⅱ) overt-HBI to OBI,(Ⅲ) OBI to OBI,and(Ⅳ) OBI to overt-HBI.In the real world,current neonatal immunization strategy is based on mothers′ status of overt-HBI and has successfully blocked the type-Ⅰ transmission.However,the effects of HBV vaccine on the other three types are not clear.In this review,we focus on the threat and epidemic of OBI and describe the relationship between the four transmission types above and efficacy of HBV vaccination.We found that,in post-immunization era,the type Ⅱ may dominate mother-to-infant transmission of HBV.More studies on OBI should be conducted to reassess the effect of existing hepatitis B immunization strategies on HBV mother-to-child transmission.

关 键 词：乙型肝炎病毒 隐匿性乙肝感染 母婴传播 免疫效果 免疫策略 

分 类 号：R512.62[医药卫生—内科学]