全身免疫炎症指数与替诺福韦乙肝母婴阻断效果的关系  

Relationship between systemic inflammatory immune index and blocking effect of tenofovir of hepatitis B from mother to child

作　　者：刘晓东 任志菲 LIU Xiaodong;REN Zhifei(Department of Obstetrics,Ningxia Women and Children's Hospital,Peking University First Hospital/Ningxia Women and Children's Hospital,Yinchuan,750000,China)

机构地区：[1]北京大学第一医院宁夏妇女儿童医院/宁夏回族自治区妇幼保健院产科,银川750000

出　　处：《湖南师范大学学报（医学版）》2024年第4期87-92,共6页Journal of Hunan Normal University(Medical Sciences)

基　　金：宁夏自然科学基金项目“HBIG联合乙肝疫苗模式对宁夏地区乙肝母婴阻断的效果及其影响因素研究”(2021AAC03412)。

摘　　要：目的:分析全身免疫炎症指数(systemic immune inflammatory index,SII)与替诺福韦(tenofovir,TDF)乙肝母婴阻断效果的关系。方法:于2019年6月―2023年6月在本院招募乙型肝炎病毒(HBV)感染孕妇148例。检测HBV感染产妇分娩时的HBV DNA载量、HBeAg阳性例数、基线中性粒细胞、基线SII、分娩时中性粒细胞、CD4^(+)T细胞数量,比较母体经替诺福韦治疗后所产婴儿6月龄时的HBsAg和抗-HBs结果,判断全身免疫炎症指数与TDF的阻断效果。TDF阻断母婴传播(mother to child transmission,MTCT)失败定义为6个月大时HBsAg检测阳性。婴儿免疫失败定义为6个月大时抗-HBs抗体水平<10 IU/L。结果:在148名6月龄幼儿中,发现6名婴儿HBsAg阳性。与HBsAg阴性婴儿组相比,HBsAg阳性婴儿组产妇分娩时HBV DNA载量、HBeAg阳性例数、基线中性粒细胞、基线SII、分娩时中性粒细胞、分娩时SII均显著增加,和分娩时CD4^(+)T细胞显著降低。基线SII和分娩时SII均与分娩时HBV DNA载量呈显著正相关性(r=0.320、0.201,均P<0.05),并且基线SII与基线CD4^(+)T细胞呈显著负相关性(r=-0.183,P=0.026)。二元Logical回归分析显示,基线SII(OR=1.003,95%CI:1.000~1.007)是婴儿HBV病毒感染的独立影响因素(P=0.044)。132例(88%)6个月大的婴儿血清中抗-HBs抗体滴度≥10 IU/L,判断为免疫成功。与婴儿免疫预防成功组相比,婴儿免疫预防失败组基线SII显著增加。结论:在感染HBV病毒的孕妇中使用替诺福韦(TDF)可有效阻断母婴传播(MTCT),孕妇基线SII水平升高可能是导致TDF阻断失败的重要因素。Objective To analyze the relationship between systemic immune inflammatory index (SII) and the blocking effect of tenofovir (TDF) on hepatitis B.Methods This was a retrospective,single-center study.From June 2019 to June 2023,148 pregnant women infected with hepatitis B virus (HBV) were recruited from our hospital.The HBV DNA load,HBeAg positive cases,baseline neutrophils,baseline SII,and the number of CD4~+T cells of neutrophils at delivery were detected.The HBsAg and anti-HBs results of infants born after tenofovir treatment were compared,and the blocking effect of systemic inflammatory immune index and tenofovir was judged.The failure of TDF to block MTCT was defined as HBsAg positive at 6 months old.Infant immune failure is defined as the level of anti-HBs antibody < 10 IU/L at 6 months old.Results Among 148 infants evaluated at 6 months,6 infants were found to be HBsAg positive.Compared with the HBsAg negative infant group,the HBV DNA load,HBeAg positive cases,baseline neutrophils,baseline SII,neutrophils and SII at delivery in the HBsAg positive infant group increased significantly,and CD4~+T cells decreased significantly at delivery.Both baseline SII and SII at delivery were positively correlated with HBV DNA load at delivery (r=0.320 and 0.201,both P< 0.05),and the baseline SII was negatively correlated with baseline CD4~+T cells (r=-0.183,P=0.026).Binary logistic regression analysis showed that baseline SII (OR=1.003,95%CI 1.000-1.007) was an independent influencing factor of HBV infection in infants (P=0.044).132 cases (88%) of 6-month-old infants had anti-HBs antibody titers ≥ 10 IU/L.Compared with the successful infant immunization group,the baseline SII of the failed infant immunization group increased significantly.Conclusion The use of TDF in pregnant women infected with HBV can effectively block MTCT,and the increase of baseline SII level in pregnant women may be an important factor leading to the failure of TDF blocking.

关 键 词：全身免疫炎症指数 替诺福韦 乙型肝炎 母婴传播 孕妇 

分 类 号：R512.6[医药卫生—内科学]