2009年至2016年延安市乙肝联合免疫阻断的影响因素和疫苗接种后血清学检测分析  

Influencing factors of hepatitis B combined immune blocking and post-vaccine serological testing in Yan’an city from 2009 to 2016

作　　者：南延荣[1] 孙晨阳 张娅楠 李红梅[1] NAN Yanrong;SUN Chenyang;ZHANG Yanan;LI Hongmei(Department of Gynecology and Obstetrics,Affiliated Hospital of Yan’an University,Yan'an 716000,China)

机构地区：[1]延安大学附属医院妇产科,陕西延安716000

出　　处：《现代医学》2020年第9期1130-1135,共6页Modern Medical Journal

基　　金：陕西省延安市科技惠民计划项目(2017HM-02-01)。

摘　　要：目的:探讨影响乙型肝炎病毒(HBV)联合免疫对母婴传播的影响因素以及HBsAg阳性母亲所分娩新生儿免疫应答率的变化。方法:收集2009年1月至2016年12月于我院收治并分娩的HBsAg阳性母亲1303例及其所分娩的儿童1311例的临床数据,使用多因素方差分析和Logistic回归分析横向研究影响母婴传播的因素;并电话召回其子女于我院检验科通过化学发光微粒子免疫分析法(CMIA)检测乙肝血清标志物定量(HBVM)水平,纵向比较不同年龄阶段儿童的血清学检测结果波动情况。结果:HBsAg阳性儿童22例,母婴阻断成功率为97.66%(918/940);疫苗接种后血清学检测(PVST)时间间隔为2~9年,儿童抗HBs的阳性率分别为0.96%、0.92%、0.94%、0.86%、0.83%、0.78%、0.70%及0.78%;随着PVST时间间隔的延长,HBV母亲所分娩的新生儿和儿童无应答率和低应答率逐渐增高,中应答率和高应答率逐渐降低。母亲HBsAg定量(OR=1.41495%CI为0.000~7.223,P=0.015)、母亲HBeAg定量(OR=4.341,95%CI为0.001~30.012,P=0.041)、母亲HBV DNA拷贝数(OR=21.20295%CI:3.005~51.380 P=0.003)及母亲孕中期性行为次数(OR=7.795,95%CI为3.135~19.385,P=0.000)为母婴传播(MTCT)的风险因素;孕妇年龄、胎次、孕期是否注射HBIG、是否胎膜早破、分娩方式、母亲有乙肝一级家族史、新生儿性别、新生儿体重、喂养方式均与母婴阻断失败无相关性。结论:母亲HBsAg定量、母亲HBeAg定量、母亲HBV DNA拷贝数及母亲孕中期性行为次数4个因素会增加MTCT的机率,孕期给予孕产妇良好的咨询及相应的干预措施,可有效地降低MTCT;积极推广PVST的实施,可早期识别抗体滴度弱或无抗体的儿童,并及时提供补种疫苗和随访。Objective:To explore the influencing factors of mother-to-child transmission of hepatitis B virus(HBV)combined immunization and the changes in the immune response rate of newborns delivered by HBsAg positive mothers.Methods:The clinical data of 1303 HBsAg positive mothers who were treated and delivered at the Yan’an University Affiliated Hospital from January 2009 to December 2016 and 1311 children delivered were collected.Multivariate analysis of variance and Logistic regression were used to analyze the lateral data.The factors that affected mother-to-child transmission were studied and their children were called back to test the level of hepatitis B virus serologic marker(HBVM)by chemiluminescence microparticle immunoassay(CMIA).In addition,The fluctuations of serological test in children of different ages were compared longitudinally.Results:Twenty-two children were positive for HBsAg,and the success rate of mother-to-child blocking was 97.66%(918/940).The post-vaccination serological testing(PVST)interval was 2 to 9 years,and the positive rates of anti-HBs in children were 0.96%,0.92%,0.94%,0.86%,0.83%,0.78%,0.70%,and 0.78%.With the prolongation of the PVST interval,the non-response rate and low-response rate of newborns and children delivered by HBV mothers gradually increased,and the medium-response rate and high-response rate gradually decreased.Quantitative HBs Ag of mother(OR=1.41495%CI 0.000~7.223,P=0.015),quantitative HBeAg of mother(OR=4.34195%CI 0.001~30.012 P=0.041),HBV DNA copy number of mother(OR=21.20295%CI 3.005~51.380,P=0.003)and the number of sexual intercourse during the second trimester of pregnancy(OR=7.79595%,CI3.135~19.385,P=0.000)were risk factors for mother-to-child transmission(MTCT).Maternal age,parity,whether to inject HBIG during pregnancy,and to have premature rupture of membranes,mode of delivery,a first-degree family member with HBV,neonatal sex,neonatal weight,feeding method were not related the failure of maternal and infant block.Conclusion:HBsAg quantification,HBeAg quantif

关 键 词：乙肝母婴传播 抗体滴度 疫苗接种后血清学检测 

分 类 号：R512.6[医药卫生—内科学] R186[医药卫生—临床医学]