乙型肝炎表面抗原阳性母亲婴儿联合免疫后抗体水平影响因素分析  

Multivariate analysis of factors influencing serum anti-HBs levels in infants of HBsAg-positive mothers after combined passive and active immunization

作　　者：郭果 张雪峰 郭明 Guo Guo;Zhang Xuefeng;Guo Ming(Department of Neonatology,Fifth Medical Center of Chinese PLA General Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院第五医学中心新生儿科,北京100039

出　　处：《中华新生儿科杂志（中英文）》2020年第5期341-345,共5页Chinese Journal of Neonatology

摘　　要：目的探讨乙型肝炎(简称乙肝)表面抗原(hepatitis B surface antigen,HBsAg)阳性母亲婴儿进行乙肝免疫球蛋白(hepatitis B immunoglobulin,HBIG)及乙肝疫苗联合免疫后血清乙肝表面抗体(hepatitis B surface antibody,anti-HBs)水平的影响因素。方法回顾性分析2012年1月至2017年12月解放军总医院第五医学中心新生儿科收治的母亲HBsAg阳性、生后进行HBIG及乙肝疫苗联合免疫且在联合免疫后24 h内进行乙肝五项检查的新生儿,收集母亲及新生儿的相关临床资料,根据联合免疫后24 h内血清anti-HBs结果将患儿分为低免疫状态组(anti-HBs<100 mIU/ml)和高免疫状态组(anti-HBs≥100 mIU/ml),比较两组母亲HBeAg状态、乙肝病毒(hepatitis B virus,HBV)DNA载量、围产期相关因素及婴儿7月龄时乙肝五项随访结果。应用SPSS 20.0统计软件进行数据分析。结果共纳入HBsAg阳性母亲新生儿207例,联合免疫后24 h内98.6%(204/207)血清anti-HBs水平>10 mIU/ml,81.2%(168/207)血清anti-HBs水平≥100 mIU/ml。单因素分析显示,高免疫状态组新生儿胎龄、出生体重低于低免疫状态组,母亲年龄>35岁、母亲HBeAg阳性及母孕28周血清HBV-DNA载量≥108 IU/ml比例高于低免疫状态组,差异有统计学意义(P<0.05)。Logistic回归分析显示出生体重是影响HBsAg阳性母亲婴儿生后24 h内血清anti-HBs滴度的相关因素。HBsAg阳性母亲婴儿7月龄时anti-HBs水平与联合免疫后24 h内血清anti-HBs水平无明显相关性。结论HBsAg阳性母亲婴儿联合免疫后24 h内血清anti-HBs水平与新生儿出生体重相关,与7月龄血清anti-HBs水平无明显相关性。Objective To study the influencing factors for the serum hepatitis B surface antibody(anti-HBs)levels in neonatal infants with Hepatitis B surface antigen(HBsAg)positive mothers after combined immunization with hepatitis B immunoglobulin(HBIG)and hepatitis B vaccine.Method From January 2012 to December 2017,infants with HBsAg-positive mothers admitted to the neonatal department of our hospital were retrospectively studied.After birth,these infants received both HBIG and hepatitis B vaccine as soon as possible.Anti-HBs tests were conducted within 24 hours after the combined immunization.Clinical data of mothers and infants were collected.Based on the serum anti-HBs results within 24 hours after combined immunization,the children were assigned into low immunity group(anti-HBs<100 mIU/ml)and high immunity group(anti-HBs≥100 mIU/ml).The mothers'hepatitis B status and related factors during perinatal period were compared between the two groups.Statistical analysis was performed using SPSS 20.0 software.Result After combined immunization,98.6%(204/207)infants with HBsAg-positive mothers had serum anti-HBs levels>10 mIU/ml and 81.2%(168/207)infants had serum anti-HBs levels≥100 mIU/ml.Univariate analysis found that statistically significant differences existed in gestational age,birth weight,mother's age,mother's prenatal HBeAg status,and hepatitis B virus(HBV)-DNA level at 28-week of pregnancy between the low-and high-immunity groups.Logistic regression analysis showed that birth weight was an influencing factor affecting serum anti-HBs titers within 24 hours after combined immunization.No significant correlation existed between anti-HBs levels at 7-month of age and serum anti-HBs levels within 24 h after combined immunization.Conclusion The serum anti-HBs levels of infants with HBsAg-positive mothers after combined immunization are mainly related with the birth weight of the newborn and do not affect the serum anti-HBs levels at 7-month of age.

关 键 词：肝炎 乙型 免疫 主动 免疫 被动 母婴传播 

分 类 号：R722.13[医药卫生—儿科]