HBV感染孕妇所分娩婴儿对乙肝疫苗免疫持久性观察  

Observation on the persistence of hepatitis B vaccine immunization in infants delivered by pregnant women with HBV infection

作　　者：范志颖 朱丽影[1] 于雷[1] 钟丽华[1] 卢宝玲[1] 程昱[1] 王媛媛[1] 樊健[1] 姚红[1] FAN Zhi-ying;ZHU Li-ying;YU Lei;ZHONG Li-hua;LU Bao-ling;CHENG Yu;WANG Yuan-yuan;FANJian;YAO Hong(Department of Infectious Diseases, the Fourth Affiliated Hospital of Harbin Medical University, Harbin 150000, China)

机构地区：[1]哈尔滨医科大学附属第四医院感染科一病区

出　　处：《中国肝脏病杂志（电子版）》2019年第2期54-59,共6页Chinese Journal of Liver Diseases：Electronic Version

基　　金：吴阶平医学基金项目(320.6750.18012);黑龙江省博士后科研启动金资助(LBH-Q14115)

摘　　要：目的观察乙型肝炎病毒(hepatitis B virus,HBV)感染孕妇所分娩婴儿对乙肝疫苗免疫的持久性.方法选取2016年9月至2018年6月在哈尔滨医科大学附属第四医院就诊的HBV感染和未感染孕妇共90例,以其分娩的90例婴幼儿为观察对象.其中HBV感染孕妇(60例)根据其妊娠期间是否口服替诺福韦酯(tenofovir disoproxil fumarate,TDF)分为抗病毒治疗组(30例)和未抗病毒治疗组(30例),抗病毒治疗组孕妇所分娩婴幼儿30例,未抗病毒治疗组30例.未感染HBV孕妇所分娩的30例婴幼儿为健康对照组.所有婴幼儿均于0、1、6个月注射乙肝疫苗,HBsAg阳性孕妇分娩的婴幼儿在出生后12 h内注射乙肝免疫球蛋白(hepatitis B immunoglobulin,HBIG).记录3组孕妇的分娩年龄、孕周及有无相关妊娠合并症、并发症,所分娩婴幼儿的体质量及性别.观察所有婴幼儿7月龄时HBsAg及HBV DNA阳性率,进一步观察7月龄、10月龄、1周岁、1.5周岁和2周岁时HBsAb滴度及其变化趋势.结果 3组孕妇的分娩年龄、孕周,所分娩婴幼儿的体质量及性别差异无统计学意义(P>0.05);3组婴幼儿7月龄时HBsAg及HBV DNA阳性率均为0.00%,HBsAb滴度差异无统计学意义(P>0.05).HBV感染孕妇所分娩的婴幼儿,从10月龄开始其HBsAb滴度均显著低于正常对照组(P<0.05);抗病毒治疗组和未抗病毒治疗组HBV感染孕妇所分娩婴幼儿7月龄、10月龄、1周岁、1.5周岁及2周岁时HBsAb滴度差异无统计学意义(P>0.05),但与正常对照组婴幼儿相比,HBsAb下降较快.结论 HBV感染孕妇所分娩婴幼儿在完成乙肝疫苗全程计划免疫后,7月龄时HBsAb滴度较正常婴幼儿无显著差异,但7月龄后其HBsAb滴度随时间下降较快,需密切观察,以降低产后婴幼儿HBV感染风险.Objective To observe the persistence of hepatitis B vaccine immunization in infants delivered by pregnant women with HBV infection. Methods A total of 90 pregnant women with and without HBV infection in the Fourth Affiliated Hospital of Harbin Medical University from September 2016 to June 2018 were selected and their infants and toddlers were taken as the objects of observation. The pregnant women with HBV infection (60 cases) were divided into antiviral treatment group (30 cases) and non-antiviral treatment group (30 cases) according to whether or not they took tenofovir disoproxil fumarate (TDF) orally during pregnancy. There were 30 infants in antiviral treatment group and non-antiviral treatment group, respectively. Thirty infants delivered by healthy pregnant women were as healthy controls. All infants and young children were injected with hepatitis B vaccine at 0, 1, and 6 months. In addition, infants delivered by HBsAg-positive pregnant women were injected with hepatitis B immunoglobulin (HBIG) within 12 hours after delivery. The childbirth age, gestational age, related pregnancy complications and the weight and gender distribution of the infants and young children were recorded. The positive rate of HBsAg and HBV DNA in infants at the age of 7 months, the HBsAb and its dynamic trends at 7 months, 10 months, 1 year, 1.5 years and 2 years old were also observed. Results There were no significant differences in the delivery age and gestational weeks of pregnant women and the weight and gender of the infants (P > 0.05). The HBsAg and HBV DNA positive rates of infants in three groups were all 0.00% at the age of 7 months, and there was no significant difference in HBsAb (P > 0.05). However, the HBsAb of infants and young children in antiviral treatment group and non-antiviral treatment group were significantly lower than that of healthy control group from the age of 10 months (P < 0.05). There were no significant differences in HBsAb of infants and young children between antiviral treatment group and non-anti

关 键 词：肝炎病毒 乙型 母婴阻断 婴幼儿 乙肝疫苗 乙型肝炎表面抗体 

分 类 号：R714.251[医药卫生—妇产科学]