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-现代医学

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

单位：延安大学附属医院妇产科, 陕西延安 716000

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.

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