乙肝病毒表面抗原阳性产妇所生婴儿乙型肝炎疫苗无/弱应答情况及影响因素分析  

Influencing factors of non-/low-response to hepatitis B vaccine of infants born to mothers infected with HBV

作　　者：杨文娟 高峰 张书豪 饶金[2] 胡芳 Yang Wenjuan;Gao Feng;Zhang Shuhao;Rao Jin;Hu Fang(Department of Child Health Care,Nansha District Maternal and Child Health Care Center,Guangzhou 510260,Guangdong,China;Guangdong Provincial Women and Child Health Care Center,Guangzhou 511442,Guangdong,China;Department of Child Health Care,Guangzhou Women and Children’s Medical Center,Guangzhou 510623,Guangdong,China)

机构地区：[1]广州市南沙区妇幼保健院儿童保健部,广东广州510260 [2]广东省妇幼保健院,广东广州511442 [3]广州市妇女儿童医疗中心儿童保健部,广东广州510623

出　　处：《疾病监测》2022年第12期1552-1557,共6页Disease Surveillance

基　　金：广州市卫生健康委科技一般引导项目(No.20191A011022);中国疾病预防控制中心妇幼保健中心母婴营养与健康研究项目(No.2020FYH007);广州市妇女儿童医疗中心/儿科研究所内部科研项目(No.YIP-2019-001)。

摘　　要：目的探讨乙型肝炎(乙肝)病毒表面抗原(HBsAg)阳性母亲所生婴儿对乙肝疫苗无/弱应答发生情况以及影响因素。方法对2018—2021年在广州市南沙区HBsAg阳性母亲所生的全部婴儿进行追踪随访,对随访成功的婴儿检测外周血乙肝病毒血清标志物,并采用结构化问卷收集相关的可能影响婴儿乙肝疫苗无/弱应答的因素。结果在婴儿7~12月龄进行电话召回,共招募随访640对HBsAg阳性产妇及所生婴儿,2名(0.31%)婴儿感染乙肝病毒,婴儿对乙肝疫苗无/弱应答发生率为2.81%(18/640),其中无应答发生率为0.31%(2/640),弱应答发生率为2.50%(16/640)。因素分析发现,HBsAg阳性产妇所生婴儿对乙肝疫苗无/弱应答与强应答组在母亲婚姻状况、文化程度、是否为HBeAg阳性、孕期HBV DNA情况、分娩方式、分娩胎龄、出生体重、婴儿性别、是否12 h内接种首剂乙肝疫苗以及乙肝免疫球蛋白方面差异均无统计学意义(P>0.05)。HBeAg阳性或孕期HBV DNA高水平母亲,47.65%(81/170)孕期进行了抗病毒治疗,其所生婴儿12 h内接种首剂乙肝疫苗、乙肝免疫球蛋白的比例略高于HBeAg阴性或孕期HBV DNA低水平母亲所生婴儿,两组婴儿乙肝疫苗无/弱应答发生率差异无统计学意义(P>0.05)。结论随着消除乙肝母婴传播工作的逐步推进,HBsAg阳性产妇所生婴儿发生母婴传播、乙肝疫苗无/弱应答较以往研究明显降低。今后应进一步强化首剂乙肝疫苗、乙肝免疫球蛋白接种时限,及对孕期HBV DNA高水平或HBeAg阳性孕妇知情告知后进行抗病毒治疗。Objective To investigate the incidence and influencing factors of non-/low-response to hepatitis B vaccine in infants born to HBsAg-positive mothers.Methods All infants born to HBsAg-positive women in Nansha district of Guangzhou during 2018-2021 were surveyed.Serum markers of hepatitis B virus(HBV)infection in peripheral blood were detected for the infants in follow up,and two structured questionnaires were used to collect the information about related factors that might affect non-/low-response to hepatitis B vaccine in the infants.Results A total of 640 HBsAg-positive mothers and their infants were recruited through telephone interview at 7-12 months after delivery.Two infants(0.31%)were infected with HBV.The incidence of non-/low-response to hepatitis B vaccine was 2.81%(18/640),and the incidence of nonresponse was 0.31%(2/640),the incidence of low-response was 2.50%(16/640).Univariate analysis found that there were no significant differences in maternal marital status,education level,HBeAg status,HBV DNA level during pregnancy,delivery mode and gestational weeks at delivery,infant birth weight,gender,and whether vaccinated the first dose of hepatitis B vaccine and hepatitis B immunoglobulin within 12 hours after birth between the infants with non-/low-response to hepatitis B vaccine and those with strong-response to hepatitis B vaccine(P>0.05).For the HBeAg-positive mothers or mothers with high levels of HBV DNA during pregnancy,47.65%(81/170)received antiviral therapy,and the proportions of their infants who received the first dose of hepatitis B vaccine and hepatitis B immunoglobulin within 12 hours after birth were slightly higher than those of infants born to women with negative-HBe Ag or low-levels of HBV DNA during pregnancy.There was no significant difference in the incidence of non-/low-response to hepatitis B vaccine between the two groups(P>0.05).Conclusion With the progress of the elimination of mother-to-child transmission of hepatitis B,the incidence rates of the mother-to-child transmission and

关 键 词：HBSAG阳性 乙型肝炎疫苗 婴儿 无/弱应答 抗病毒治疗 

分 类 号：R211[医药卫生—中医学] R512.62