影响乙肝病毒母婴传播中新生儿乙肝表面抗原转阴的因素探讨

Study of the influencing factors about the HBsAg negative conversion of newborns of mother and infant vertical transmission

目的:探讨乙型肝炎病毒携带孕妇的新生儿出生24h内及6月龄时乙肝病毒标志物的转归以及影响新生儿乙肝病毒表面抗原(HBsAg)转阴有关因素。方法:对490例HBsAg阳性孕妇及其新生儿进行追踪观察,按知情同意原则将孕妇分为孕晚期注射乙肝免疫球蛋白组(HBIG组)和孕期不注射HBIG组(对照组)。其中HBIG组334人,采取从妊娠28周起,每月注射HBIG200IU直至临产,对照组156人只做常规产检不注射HBIG。分娩后,采集新生儿出生24h内、及6月龄时的外周静脉血,检查乙肝标志物,所有孕产妇所生新生儿出生24h内都肌肉注射HBIG100IU,同时在不同部位按0、1、6月龄肌肉注射5μg乙肝疫苗。结果:①490例新生儿出生24h的乙肝标志物检测中有60例HBsAg阳性,其中母亲产前注射HBIG组35人,对照组25人;到6月龄时HBIG组婴儿有28例转阴,HBsAg转阴率为80.0%(28/35),对照组婴儿有14例转阴,转阴率为56.0%(14/25),两组间差别有统计学意义(P<0.05)。②在60例出生24h内HBsAg阳性的新生儿中,HBsAg、HBeAg同时阳性者(双阳组)有34人,HBsAg阳性而HBeAg阴性(单阳组)有26人。6月龄时检测婴儿乙肝标志物,双阳性组有19例转为阴性,HBsAg转阴率为55.9%(19/34),而单阳性组有23例HBsAg转阴,其HBsAg转阴率为88.5%(23/26),两组间差别有统计学意义(P<0.05)。③490例婴儿出生后6月龄时抗-HBs阳性率在注射组为81.4%(272/334),对照组为52.6%(82/156),其差别十分显著(P<0.001)。结论:孕晚期母亲注射HBIG能促进出生24h内HBsAg阳性新生儿的6月龄HBsAg阴转率,同时显著提高6月龄婴儿抗-HBs阳性率;出生24h内HBsAg、HBeAg同时阳性的新生儿,6月龄HBsAg阴转率较低。

Objective： To investigate the hepatitis B virus （HBV） serological markers conversion results of the newborns after birth within 24 hours and at 6 months of age, whose mother are hepatitis B surface antigen carrier, and study the influencing factors about the HB- sAg negative of these newborns. Methods： 490 women carrying HBsAg were divided into 2 groups randomly. In the hepatitis B immunoglob- ulin （HBIG） group, 334 pregnant women were injected with HBIG 200 IU every 4 weeks during pregnancy since the 28th week of gestation. In the control group, 156 pregnancy women were only given common antenatal care without injection of HBIG. After delivery, the newborns blood of peripheral vein were collected when they were 24 - hours - old and 6 - month - old to test the HBV serological markers. All the new- borns in the two groups were injected HBIG after born in 24 hours, at the same time at the other side immunized with 3 doses of hepatitis B vaccine routinely. Results： 60 newborns had carried HBsAg when they were 24 - hours - old. And there were 35 mothers of the newborns injected with HBIG during pregnancy, 25 mothers were not. When the infants were 6 - months - old, the HBsAg of 28 infants in the HBIG group were negative, the conversion of negative rate was 80. 0% （28/35）, the control group conversion of negative rate was 56. 0% （14/ 25）, the rate of conversion was different between the two groups （P 〈 0. 05）. Among the 60 newborns who carried HBsAg, 34 newborns who were HBeAg - positive was defined as both positive group, and 26 newborns who were only HBsAg - positive was defined as single positive group. There were 19 infants became HBsAg - negative in the both positive group, the conversion of negative rate was 55. 9% （ 19/ 34）, and in the single group there were 23 infants conversed, the rate was 88. 5% （23/26）, the rate was different between the two groups （P 〈0. 05）. Among the 490 infants who was 6 - months - old, the anti - HBs positive rate in the HBIG group was 81. 4% （272/334）, and the rate was 52. 6% （82/156）, the difference was significantly （P 〈0. 001） . Conclusion： HBIG in the trimester of pregnancy can increase the conversion of HBsAg negative rate and the HBsAb positive rate of 6 months infants. The conversion of HBsAg negative rate of the infants who HBsAg and HBeAg both positive after birth within 24 hours is lower at 6 months of age.