HBsAg阳性母亲与婴幼儿HBV血清标志物关系

Analysis on relationship between hepatitis B serologic markers in HBsAg positive mothers and their infants

目的了解HBsAg阳性母亲及其经乙肝高效价免疫球蛋白联合乙肝疫苗免疫的婴幼儿乙型肝炎病毒（HBV）血清标志物变化及转归情况。方法对125例HBsAg阳性母亲及其128例婴幼儿（双胎3例）进行随访调查,并分别于婴幼儿7月龄、24~36月龄应用酶联免疫吸附试验检测母亲和婴幼儿血清HBV主要标志物。结果7月龄随访83例婴幼儿,24~36月龄随访75对母子。128例婴幼儿出生时HBsAg阳性4例,随访时仅1例持续阳性,其余出生时HBsAg阴性的94例婴幼儿随访中未发现HBsAg阳转;HBsAg、HBeAg双阳性的26例母亲所产婴幼儿出生时20例HBeAg阳性,随访时除1例HBsAg为阳性的婴幼儿HBeAg仍持续阳性外,余均转阴,未见婴幼儿出现HBeAg阳转;婴幼儿抗-HBe和抗-HBc在7月龄和远期随访中逐渐阴转。结论乙肝病毒经胎盘所致的宫内感染率约为3.13%（4/128）,出生后转为慢性感染者约为25.00%（1/4）;HBeAg可通过人类胎盘从母亲传递给胎儿,但在7月龄前消失;出生于HBsAg阳性母亲的婴幼儿在婴幼儿期单独抗-HBe和（或）抗-HBc阳性,不能说明处于HBV感染状态。

Objective To investigate the changes and the development of hepatitis B virus serologic markers in mothers carrying hepatitis B surface antigen （HBsAg） and their infants who accepted hepatitis B immunoglobulin（HBIG）combining hepatitis B vaccine immunization by follow - up study. Methods 125 HBsAg carrier mothers and their 128 infants （3 twin pairs） were followed up. Major I-IBV serologic markers in all mothers and their infants were detected by enzyme - linked immunosorbent assay （ELISA） when infants were at month 7 and at month 24 to month 36. Results 83 infants were followed up at month 7 and 75 infants and their mothers were followed up when infants were at month 24 to month 36. Of 128 infants born to HBsAg-positive mothers, 4 infants were HBsAg positive at birth, only 1 infant who was born from HBsAg-positive and HBeAg（hepatitis B e antigan）-positive mother was persistently positive sera for HBsAg. The other 94 infants were negative HBsAg. Of 26 infants born to HBsAg-positive and HBeAg-positive mothers, 20 showed detectable levels of HBeAg. HBeAg were still detectable in 1 infant who was also HBsAg positive and the others all became HBeAg-negative during follow-up period. No infant became HBeAg-positive. Hepatitis B e antibody（anti-HBe） and hepatitis B core antibody（anti-HBc） in the infants disappeared gradually in the short-term and long＇term follow- up. Conclusion The transplacental intrauterine infection rate of HBV was about 3.13 % （4/128）, and the chronic infection rate of HBV was about 25.00% （1/4）. The maternal HBeAg may pass through placenta from mother to fetus, but it will disappear in 7 months in the infants. The sole existence of anti-HBe and （or） anti-HBc in infants simply represented the transplacental maternal antibodies to the fetus, and may not in- dicate that infants experience HBV infection actively or previously.