新生儿静脉血HBsAg含量预测HBV母婴传播阻断效果的研究  

Study on the efficacy of neonatal HBsAg content in venous blood to predict mother-to-children transmission of hepatitis B virus

作　　者：冉崇平 张璐[2] 李明慧[2] 易为[2] 路遥[2] 周明芳[2] 胡玉红[2] 刘媛媛 万钢[2] 李俊南 谢尧[1] Ran Chongping;Zhang Lu;Li Minghui;Yi Wei;Lu Yao;Zhou Mingfang;Hu Yuhong;Liu Yuanyuan;Wan Gang;Li Junnan;Xie Yao(Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;Liver Diseases Center,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院,北京100015 [2]首都医科大学附属北京地坛医院肝病中心,北京100015

出　　处：《中华实验和临床病毒学杂志》2019年第4期419-423,共5页Chinese Journal of Experimental and Clinical Virology

基　　金：首都临床特色应用研究专项(Z151100004015122);北京市医院管理局临床医学发展专项(XMLX201706);国家科技重大专项(2017ZX10201201-001-006,2017ZX10201201-002-006);北京市医院管理中心消化内科学科协同发展中心(XXZ0302);北京市科技计划重大专项"乙型肝炎免策略及抗病毒治疗研究"(D161100002716002,D161100002716004)。

摘　　要：目的探讨新生儿静脉血HBsAg状态及其含量预测HBV母婴传播阻断的作用。方法从HBV母婴传播阻断效果前瞻性研究队列患者中入组HBsAg、HBeAg双阳性和HBV DNA含量>105 IU/ml孕妇及其新生儿。新生儿出生后6 h内注射200 IU乙肝免疫球蛋白(hepatitis B immunoglobulin,HBIG),出生后1个月自愿选择注射200 IU乙肝免疫球蛋白,并按第0、1和6个月标准程序接种乙肝疫苗10~20μg。孕妇于分娩前、新生儿出生时、出生后1个月和7个月检测静脉血HBV病毒和血清学指标,评估其与HBV母婴阻断成功的相关性。结果共入组孕妇及其所生新生儿530例。出生时60.75%和出生1个月86.02%为HBsAg阴性,HBsAg阴性新生儿的HBV母婴传播阻断成功率为100.00%,经受试者工作特征曲线分析,出生时HBsAg≥0.35 IU/ml预测阻断失败的AUC为0.979,灵敏度为85.60%,特异度为100.00%;出生后1个月HBsAg≥0.18 IU/ml预测阻断失败的AUC为0.988,灵敏度为89.40%,特异度为100.00%。结论出生时和出生后1个月新生儿静脉血HBsAg水平可预测HBV母婴传播阻断失败,静脉血HBsAg阳性的新生儿是阻断失败的高危人群。Objective To investigate the role of HBsAg status and content in neonatal venous blood to predict HBV mother-to-children transmission.Methods The study candidates from a prospective study about HBV mother-to-children transmission blocking who were hepatitis B surface antigen(HBsAg)positivity,hepatitis B e antigen(HBeAg)positivity,and HBV DNA levels>10^5 IU/ml.All of their infants were enrolled.200 IU of hepatitis B immunoglobulin(HBIG)was injected within 6 hours after birth,and 200 IU HBIG was voluntarily selected 1 month after birth.All infants according to 0-1-6 month standard procedure were given 10 or 20μg of hepatitis B vaccine.Pregnancy women before birth,and infants at the time of birth,1-month and 7-month after birth,venous blood was tested for HBV virus and serological markers to assess the association with success of mother-to-children transmission blocking.Results 530 pregnant women and 530 neonates were enrolled.60.75%at birth and 86.02%at birth for one month children were HBsAg-negative.The successful transmission in HBsAg-negative neonates was 100.00%.According to the receiver operating characteristic curve,the AUC of HBsAg content>0.35 IU/ml at birth predicted to block failure was 0.979.The sensitivity was 85.60%,and the specificity was 100.00%.The AUC of HBsAg content>0.18 IU/ml at one month after birth predicted to block failure was 0.988,the sensitivity was 89.40%,and the specificity was 100.00%.Conclusions The HBsAg level in venous blood at birth and 1 month after birth can predict the failure of HBV mother-to-children transmission,and the neonates with HBsAg positivity in venous blood are a high-risk group that may block failure.

关 键 词：表面抗原 乙型 乙肝疫苗 乙肝免疫球蛋白 预测 

分 类 号：R51[医药卫生—内科学]