乙肝病毒表面抗原阳性孕妇分娩新生儿乙肝病毒标志的临床意义

Clinical analysis of HBV markers in infants of HBsAg-positive mothers

目的探讨乙肝病毒表面抗原(HBsAg)阳性孕妇分娩新生儿乙肝病毒标志的临床意义。方法对1999-07—2002-06北京地坛医院儿科996例新生儿生后第3天检测静脉血乙肝病毒标志,追踪观察199例成长到3个月至4岁,将乙肝病毒标志HBsAg和HBeAg进行分析。结果新生儿生后第3天HBsAg和HBeAg阳性率分别为27.2%(271/996)、48.1%(479/996),有495例检测抗-HBc,阳性率高达99.2%(491/495)。在生后3个月至4岁间复测乙肝病毒标志199例,有17例感染乙肝病毒,占8.5%(17/199)。分别比较生后第3天血清HB-sAg、HBeAg滴度,感染乙肝病毒新生儿的HBsAg滴度高于未感染新生儿(P<0.01),而HBeAg滴度水平差异不明显(P>0.05)。将感染、未感染乙肝病毒儿童复查结果与生后第3天血清HBsAg、HBeAg滴度分别进行比较,17例感染乙肝病毒儿童血清HBsAg和HBeAg滴度明显升高(P<0.001,P<0.05),而182例未感染儿童明显减低(P<0.001)。结论HBsAg阳性孕妇分娩新生儿血清HBsAg、HBeAg和抗-HBc阳性不能作为诊断感染乙肝病毒的依据,新生儿血清HBsAg滴度较高并在生后3个月逐渐升高,可以作为儿童感染乙肝病毒的诊断依据。

Objective To explore clinical features of the markers in newborns of mothers with HBsAg-positive. Methods HBV markers in serum were determined in 996 infants of 3-day-old, 199 of them followed up for periods from 3 months to 4 years. Results HBsAg and HBeAg in serum in newborns of the third day of life were 27.2% （271/996） and 48. 1% （479/996）, respectively. The number of anti-HBc positive was 99. 2% （ 491/495 ）. Seventeen infants were confirmed to be HBV infection （8.5% , 17/199）. There was significant difference in the expression of HBsAg in serum in the infected infants with higher loud and HBeAg showed no significant difference as compared to non-infected infants on the third day after birth. In comparison between sera collected from the third day of age and following-up in the infected HBV children, HBsAg and HBeAg of the latter were markedly higher respectively, P 〈 0. 001, P 〈 0. 05. In non-infected HBV children（182cases） ,levels of both HBsAg and HBeAg decreased obviously, P 〈 0. 001. Conclusion The positive HBV markers in serum are predominant in newbom infants of mothers with HBsAg-positive,which can not be considered the markers of HBV infection. High levels of HBsAg and HBeAg in serum can be defined as a high predictor of children with HBV infection after 3 months of age.