乙肝表面抗原携带者不同喂养对婴儿的影响

A contrast study on influence of different feeding and immunity patterns of HBs Ag carriers on HBV horizontal transmission to their infants

目的探讨乙肝病毒表面抗原携带者不同喂养方式及婴儿不同免疫方式对乙型肝炎病毒母婴水平传播,即婴儿生后1年内乙肝抗原抗体的影响。方法对在北京市海淀区妇幼保健院分娩的母亲有乙肝表面抗原携带者的婴儿413例作为观察对象。根据喂养方式分为母乳组345例、人工组(人工喂养组)68例;根据是否用乙肝免疫球蛋白分为干预组241例,非干预组172例。观察各组婴儿生后3个月、6个月、1岁时乙肝表面抗原、乙肝e抗原定性测定和1岁时乙肝表面抗体、乙肝e抗体、乙肝核心抗体定性测定。结果乙肝病毒抗原测定:各组婴儿生后3个月、6个月、1岁乙肝表面抗原、乙肝e抗原定性检测均为阴性。1岁时乙肝病毒抗体定性测定:婴儿出生时保护性抗体阴性者1岁时乙肝表面抗体阳性率母乳组为95.9%,人工组为94.1%,经统计学处理,2χ=0.454,P=0.501,无显著性差异。乙肝表面抗体阳性率乙肝免疫球蛋白干预组为92.9%,非干预组为99.4%,经统计学处理,2χ=10.087,P=0.001,有显著性差异。结论对乙肝表面抗原单阳性母亲所生,且出生乙肝抗原阴性的婴儿应采用主动免疫"方案",按时接种乙肝疫苗母乳喂养是安全的。母乳喂养不影响接种乙肝疫苗后主动免疫的产生,母乳喂养对婴儿乙肝核心抗体阴转是有利的。乙肝免疫球蛋白被动免疫对部分婴儿乙肝疫苗主动免疫的产生存在抑制现象。

Objective To investigate influence of different feeding and immunity patterns of pregnant women on mother-to-child horizontal transmission of hepatitis B virus （HBV） （ HBV antigen and antibody levels within 1 year after birth of the infants）. Methods 413 infants whose mothers were hepatitis B superficial antigen （HBsAg） positive carriers born in Haidian District Maternal and Child Health Hospital of Beijing City were investigated. All infants were inoculated 10μg of hepatitis B vaccine （HBvac） at 0, 1, 6 months after birth routinely. According to feeding patterns, the infants were divided into breasffeeding group （ n = 345 ） and artificial feeding group （ n = 68 ）. According to presence or absence of immunity （ including active immunity, active and the passive combined immunity ） , the infants again were randorrdy divided into intervention group （n = 241 ） and non-intervention group （n = 172）. At 3months, 6months and 1 year of age, qualitative tests of HBsAg, HBsAb, HBeAg, HBeAb, HBcAb were conducted for all the infants and the results were compared. Results HBV antigen test： at 3, 6 months and 1 year of age, qualitative HBsAg and HbeAg tests of the infants in all groups were negative. HBV antibody qualitative test at 1 year of age： at 1 year of age, HBsAb positive rate in the breasffeeding group among those infants whose protective antibodies were negative at birth was 95.9% , in the artificial feeding group the HBsAb positive rate was 94.1%, the difference was not significant （χ^2=0. 454, P = 0. 501 ）. The HBsAb positive rate was 92.9% in the HBIG intervention group and 99.4% in the HBIG non-intervention group, and the difference was significant （χ^2 = 10. 087, P = 0. 001 ）. Conclusion For those infants with negative HBsAg at birth born by the mothers with single positive HBsAg, active immunity should be performed, that is, the infants can be inoculated HBvac at time and breasffeeding is comparatively safe. The breasffeeding does not affect development of active immunity after inoculating HBvac. Inversely, breasffeeding is beneficial to HBcAb of the infant inversing to negative. HBIG passive immunity could suppress development of HBvac active immunity of a part of infants.