HBV感染女性所生儿童1岁时感染状况和乙肝疫苗应答效果的真实世界研究  

A real-world study on HBV infection and response to hepatitis B vaccine in children born to HBV-infected women at one year of age

作　　者：曹秀贞[1] 陈凤欣 曾湛 杨柳 陆慧慧 王夫川 万钢 谢尧 易为[1] Cao Xiuzhen;Chen Fenxin;Zeng Zhan;Yang Liu;Lu Huihui;Wang Fuchuan;Wan Gang;Xie Yao;Yi Wei(Department of Obstetrics and Gynecology,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;The Second Department of Liver Diseases Center,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;Department of Hepatology Division 2,Peking University Ditan Teaching Hospitla,Beijing 100015,China;Medical Record Department,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妇产科,北京100015 [2]首都医科大学附属北京地坛医院肝病二科,北京100015 [3]北京大学地坛医院教学医院肝病二科,北京100015 [4]首都医科大学附属北京地坛医院病案室,北京100015

出　　处：《中华实验和临床病毒学杂志》2021年第4期372-377,共6页Chinese Journal of Experimental and Clinical Virology

基　　金：国家科技重大专项(2017ZX10203202-003,2017ZX10201201-001-006,2017ZX10201201-002-006,2018ZX10715-005-003-005);首都临床特色专项资助项目(Z151100004015122);北京市医管中心临床专项项目(XMLX 201706、XMLX 202127);北京市医管中心消化协同中心资助项目(XXT28、XXZ0302);北京市科委课题(D161100002716002)。

摘　　要：目的:探讨真实世界中慢性HBV感染女性及其所生儿童1岁时HBV感染状况、对乙肝疫苗接种的应答及其影响因素。方法:本研究为横断面研究,选取符合入组条件的慢性HBV感染母亲及完成规范接种乙肝疫苗和乙肝免疫球蛋白注射的儿童,通过医院HIS系统及LIS系统收集产妇孕期临床生化、病毒学指标、抗病毒治疗及妊娠期和分娩期并发症等信息,入组儿童1岁时儿童采取静脉血检测乙肝表面抗原(HBsAg)、表面抗体(HBsAb)和HBV DNA。结果:共收集符合条件的母亲及儿童1302例,其中高病毒载量组(母亲HBV DNA≥2×10^(5) IU/ml)600例,低病毒载量组(母亲HBV DNA<2×10^(5) IU/ml)共702例。高病毒载量组中587例孕中晚期使用抗病毒药物(用药组),13例未使用抗病毒药(未用药组)。低病毒载量组儿童无慢性HBV感染发生,高病毒载量组5例(0.83%)发生HBV感染,3例(0.51%)发生在用药组,2例(15.38%)发生在未用药组。低病毒载量组母婴阻断失败率显著低于高病毒载量组(χ^(2)=5.87,P=0.015),用药组母婴阻断失败率显著低于未用药组(χ^(2)=29.195,P=0.001)。1297例未发生HBV感染儿童HBsAb水平<10 mIU/ml、10~<100 mIU/ml和≥100 mIU/ml的百分率分别为1.15%、15.65%和83.19%。单因素和多因素Logistics回归分析均显示母亲孕期总胆红素水平和是否患甲状腺功能减退与1岁HBsAb水平相关(χ^(2)=29.003,P<0.05)。结论:高HBV病毒载量孕妇孕期服用抗病毒药物可显著降低HBV母婴传播。HBV感染女性所生儿童出生后应加强随访乙肝疫苗应答效果。Objective To explore the status of HBV infection,immune response to hepatitis B vaccine and its influencing factors of one-year old children born to HBV infected mothers in real world.Methods In this cross-sectional study,eligible mothers infected with chronic HBV and children who completed standard vaccination against hepatitis B vaccine and hepatitis B immunoglobulin injection were selected.Clinical biochemical,virological measurements,data of antiviral therapy and complications during pregnancy and childbirth were collected by HIS(Hospital Information System)system and LIS(Laboratoty Information Management System)system.At one year of age,the children were tested for HBsAg,HBsAb and HBV DNA in venous blood specimens.Results A total of 1302 eligible mothers and children were collected,including 600 in high viral load group(mothers’HBV DNA≥2×10^(5) IU/ml)and 702 in low viral load group(mothers’HBV DNA<2×10^(5) IU/ml).In high viral load group,587 patients received antiviral drugs in the middle or late trimester(Treated group)and 13 patients did not receive antiviral drugs(Untreated group).No chronic HBV infection occurred in children of low viral load group,and in 5 cases(0.83%)the infection occurred in high viral load group.In the five HBV infected children,3 cases(0.51%)were in the treated group,and 2 cases(15.38%)in untreated group.The failure rate of mother-to-child blocking in low viral load group was significantly lower than that in high viral load group(χ^(2)=5.87,P=0.015),and it was significantly lower in treated group than that in untreated group(χ^(2)=29.195,P=0.001).The percentages of HBsAb level<10 mIU/ml,10-<100 mIU/ml and≥100 mIU/ml in 1297 children without HBV infection were 1.15%,15.65%and 83.19%,respectively.Univariate and multivariate logistic regression analysis showed that maternal total bilirubin level and hypothyroidism during pregnancy were correlated with HBsAb level at 1 year of age(χ^(2)=29.003,P<0.05).Conclusions Antiviral drugs taken during pregnancy by pregnant women with

关 键 词：乙型肝炎病毒 乙肝疫苗 免疫应答 母婴传播 

分 类 号：R51[医药卫生—内科学]