福建省泉州市HBsAg阳性母亲新生儿免疫失败影响因素分析  

Risk factors of immunoprophylaxis failure of infants borned by HBsAg positive mothers in Quanzhou, Fujian

作　　者：黄彩虹[1] 陈秋婷[1] 陈雅红[1] 张扬 曾珊珊 叶振飞 HUANG Cai-hong;CHEN Qiu-ting;CHEN Ya-hong;ZHANG Yang;ZENG Shan-shan;YE Zhen-fei(Quanzhou City Center for Disease Control and Prevention,Quanzhou,Fujian 362000,China;School of Public Health,Fujian Medical University,Fuzhou,Fujian 350001,China)

机构地区：[1]泉州市疾病预防控制中心,福建泉州362000 [2]福建医科大学公共卫生学院,福建福州350001

出　　处：《中国热带医学》2021年第6期562-566,共5页China Tropical Medicine

基　　金：泉州市科技计划项目(No.2019No55S)。

摘　　要：目的探讨泉州市HBsAg阳性母亲新生儿乙肝疫苗(HepB)免疫失败的影响因素,为采取有效的干预措施提供科学依据,以进一步降低新生儿乙肝病毒感染的风险。方法采用1∶2病例对照研究的方法,分别对118对HepB免疫失败和236对免疫成功的新生儿及母亲进行调查。通过SPSS 24.0软件进行χ^(2)检验和多因素Logistic回归分析。结果HBsAg阳性母亲新生儿免疫失败与新生儿接种HepB的种类、剂量、母亲HBeAg状态和HBV DNA载量等因素有关,而与新生儿性别、分娩方式、体质重、孕周、HBIG剂量、喂养方式、胎次和母亲年龄、ALT水平、职业等因素无关联。新生儿接种20μg乙肝疫苗免疫失败的风险是接种10μg乙肝疫苗的0.147倍(OR=0.147,P<0.01);接种20μg乙肝啤酒酵母疫苗的免疫成功率最高,其次为20μg汉逊酵母疫苗;母亲HBeAg阳性新生儿HepB免疫失败的风险是母亲HBeAg阴性新生儿的4.701倍(OR=4.701,P<0.01),母亲HBV DNA阳性新生儿HepB免疫失败的风险是母亲HBV DNA阴性新生儿的21.410倍(OR=21.410,P<0.01),且母亲HBV DNA病毒载量增高新生儿免疫失败的风险越高(趋势χ_(趋势)^(2)趋势=108.922,P<0.01)。结论母亲HBeAg阳性和高病毒载量是HepB免疫失败的主要影响因素,建议在孕期对高HBV DNA病毒载量母亲进行抗病毒治疗,并为其新生儿全程接种20μg HepB,以进一步提高免疫成功率。ObjectiveTo research the influence factors about neonatal hepatitis B immunization failure borned by HBsAg positive mothers in Quanzhou City,and we provide effective intervention measures for reducing the risk of neonatal hepatitis B virus infection.MethodsA 1∶2 case-control study was conducted.We respectively launched a questionnaire survey on 118 pairs newborns and mothers who failed to immunize with HepB and 236 pairs successfully immunized.χ2test and multivariate Logistic regression analysis were performed by SPSS 24.0 software.The exact probability method and continuous correction analysis method were used at the same time.ResultsThe failure of neonatal immunization were related to the type and dose of hepatitis B vaccine,the mother’s HBeAg status and HBV DNA load.The risk of immunization failure of newborn vaccinated with 20μg hepatitis B vaccine was 0.147 times compared with who vaccinated by 10μg (OR=0.147,P<0.001).The success immunization rate was highest with 20μg Saccharomyces cerevisiae hepatitis B vaccine,followed by 20μg Hansenula polymorpha vaccine.The failure risk who borned by HBeAg-positive mother was 4.701 times compared to HBeAg-negative (OR=4.701,P<0.01).The failure risk whose mother with HBV DNA positive was 21.410 times versus those borned by negative mothers (OR=21.410,P<0.01).As the mother’s HBV DNA viral load increased,the risk of neonatal immunization failure was higher(χ2trend=108.922,P<0.001).ConclusionsPregnant women with HBeAg-positive and high HBV replication level was the major risk population of HBV mother-to-infant transmission.It was recommended that pregnant women with high HBV DNA viral load should be treated with antiviral therapy,and their newborns need to be vaccinated with 20μg hepatitis B vaccine.

关 键 词：乙肝 乙肝疫苗 HBSAG阳性母亲 免疫失败 病例对照 

分 类 号：R512.62[医药卫生—内科学]