网站首页期刊介绍通知公告编 委 会投稿须知电子期刊广告合作联系我们
最新消息:
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
作者:南延荣  孙晨阳  张娅楠  李红梅 
单位:延安大学附属医院 妇产科, 陕西 延安 716000
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;R186
出版年·卷·期(页码):2020·48·第九期(1130-1135)
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1 303例及其所分娩的儿童1 311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=1.414 95% 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=21.202 95% 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 positivemothers.Methods: The clinical data of 1 303 HBsAg positivemothers who were treated and delivered at the Yan'an University Affiliated Hospital from January 2009 to December 2016 and 1 311 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 studiedandtheir 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 childrenof 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) intervalwas 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 HBsAg of mother (OR=1.414 95% CI 0.000~7.223,P=0.015), quantitative HBeAg of mother(OR=4.341 95% CI 0.001~30.012 P=0.041), HBV DNA copy number of mother(OR=21.202 95% CI 3.005~51.380,P=0.003) and the number of sexual intercourse during the second trimester of pregnancy (OR=7.795 95%,CI 3.135~19.385,P=0.000)were risk factors for mother-to-child transmission(MTCT). Maternal age, parity, whether to inject HBIG during pregnancy, and to havepremature 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 quantification, HBV DNA levels of mothers and the number of sexual intercourse during the second trimester of pregnancy are the factors that increase the chances of MTCT. Therefore, giving good counseling and corresponding interventions to them during pregnancy can effectively reduce MTCT. Promoting the implementation of PVST actively can identify children with weak antibody titers or no antibodies early, and provide timely reinoculation vaccines and follow-up.

参考文献:

[1] LIU J,ZHANG S,WANG Q,et al.Seroepidemiology of hepatitis B virus infection in 2 million men aged 21-49 years in rural China:a population-based,cross-sectional study[J].Lancet Infect Dis,2016,16(1):80-86.
[2] DUSHEIKO G,AGARWAL K.Delineating the global challenges of hepatitis B virus infection[J].Lancet Gastroenterol Hepatol,2018,3(6):372-373.
[3] PENG S,WAN Z,LIU T,et al.Incidence and risk factors of intrauterine transmission among pregnant women with chronic hepatitis B virus infection[J].J Clin Gastroenterol,2019,53(1):51-57.
[4] 中华医学会感染病学分会,Grade中国中心.中国乙型肝炎病毒母婴传播防治指南(2019年版)[J].中华传染病杂志,2019,37(7):388-396.
[5] 李克勇,刘沛.乙肝疫苗和乙肝免疫球蛋白联合应用阻断乙肝母婴传播的Meta分析[J].东南大学学报(医学版),2007,26(1):43-45.
[6] 朱桂琴.重组乙型肝炎疫苗联合乙肝免疫球蛋白阻断乙肝母婴传播的效果及相关因素分析[J].中国妇幼保健,2017,32(5):965-968.
[7] World Health Organization.Global hepatitis report,2017[EB/OL].https://apps.who.int/iris/bitstream/handle/10665/255016/9789241565455-eng.pdf?sequence=1.
[8] SCHILLIE S,VELLOZZI C,REINGOLD A,et al.Prevention of hepatitis B virus infection in the united states:recommendations of the advisory committee on immunization practices[J].MMWR RecommendationsReports,2018,67(1):1-31.
[9] 贾继东,李兰娟.慢性乙型肝炎防治指南(2010年版)[J].临床肝胆病杂志,2011,27(1):113-128.
[10] 中华医学会妇产科学分会产科学组.乙型肝炎病毒母婴传播预防临床指南(第1版)[J].中华妇产科杂志,2013,48(2):151-154.
[11] 国务院新闻办公室网站.中共中央关于全面深化改革若干重大问题的决定[EB/OL].http://www.scio.gov.cn/zxbd/nd/2013/document/1374228/1374228.htm.
[12] INSULANDER M,LINDH G,STENKVIST J,et al.Long-term follow-up of a vaccination program for infants born to HBsAg-positive mothers in Stockholm county,Sweden[J].Vaccine,2020,38(4):790-793.
[13] 任坤岭,崔秀华,王晓琼,等.联合免疫阻断乙型肝炎病毒母婴传播效果及影响因素研究[J].中国预防医学杂志,2018,19(9):660-663.
[14] 王璐,代晶芳,张国梅.HBV高病毒载量孕妇与新生儿宫内感染的相关性分析[J].中华医院感染学杂志,2018,28(4):586-589,597.
[15] 曹敏恺,胡玲卿,赵丽.妊娠晚期应用替比夫定阻断乙型肝炎病毒母婴传播的效果[J].现代医学,2016,44(3):292-295.
[16] YONGHAO G,PUMEI D,JIANHUI Y,et al.A retrospective study of hepatitis B mother-to-child transmission prevention and post-vaccination serological test results of infants at risk of perinatal transmission in two counties of middle China[J].J Viral Hepat,2017,24(8):687-695.
[17] GILES M L,GRACE R,TAI A,et al.Prevention of mother-to-child transmission of hepatitis B virus (HBV) during pregnancy and the puerperium:current standards of care[J]. Aust NZ J Obstet Gyn,2013,53(3):231-235.
[18] WANG F,ZHANG G,ZHENG H,et al.Post-vaccination serologic testing of infants born to hepatitis B surface antigen positive mothers in 4 provinces of China[J].Vaccine,2017,35(33):4229-4235.
[19] Global health sector strategy on viral hepatitis 2016-2021[EB/OL].http://www.who.int/hepatitis/strategy2016-2021/ghss-hep/en.
[20] ZHENG H,ZHANG G M,CHAN P L,et al.Compliance among infants exposed to hepatitis B virus in a post-vaccination serological testing program in four provinces in China[J].Infect Dis Poverty,2019,8(1):57.

服务与反馈:
文章下载】【发表评论】【查看评论】【加入收藏
提示:您还未登录,请登录!点此登录
您是第 399332 位访问者


 ©《现代医学》编辑部
联系电话:025-83272481;83272479
电子邮件: xdyx@pub.seu.edu.cn

苏ICP备09058541