乙肝疫苗对乙肝病毒携带者子女的免疫效应

Immunological effect of hepatitis B vaccine on infant whose mother was hepatitis B virus carrier

目的了解乙肝疫苗免疫效应在乙肝病毒携带者子女接种疫苗后的持续时间，从而探讨乙肝疫苗复种时间及婴儿出生时注射乙肝免疫球蛋白对乙肝疫苗免疫效应的影响。方法对在北京市海淀区妇幼保健院出生的母亲为乙肝表面抗原阳性的婴儿进行观察，这些婴儿出生时乙肝表面抗原和乙肝e抗原均为阴性，所有观察对象均采用乙肝疫苗按0、1、6个月各10μg方案接种。观察对象的母亲随机分为观察1组和观察2组，观察1组婴儿生后不注射乙肝免疫球蛋白，观察2组婴儿生后24小时内注射乙肝免疫球蛋白100～200U，生后15～30天重复1次。在婴儿每满周岁时进行定期抽取静脉血检测乙肝保护性抗体乙肝表面抗体定量，并检测乙肝表面抗原和乙肝e抗原定性。乙肝表面抗体定量〈100mU／mL者予以乙肝疫苗10μg加强接种。结果①观察母亲为乙肝病毒携带者的1岁婴儿316例，乙肝表面抗体定量〉100mU／mL者有162例（51．3％）；②婴儿2岁时观察其1岁时乙肝表面抗体定量〉100mU／mL的未加强接种乙肝疫苗者乙肝表面抗体定量〉100mU／mL仅有26例（26／266，9．8％），与婴儿1岁时乙肝表面抗体定量〉lOOmU／mL者比较有非常显著性差异（χ^2=113．698，P=0．000）；③婴儿1岁时观察1组乙肝表面抗体定量〈100mU／mL者48例；观察2组乙肝表面抗体定量〈100mU／mL有106例，经比较两组有显著性差异（χ^2=4．892，P=0．027）。结论①婴儿经乙肝疫苗3次10μg接种后，对母亲乙肝病毒抗原阳性的高危儿童建立长期随访机制很有必要；②对于保护性抗体乙肝表面抗体不足者应加强疫苗接种；③1岁和2岁时观察1组的婴儿乙肝表面抗体定量〉100mU／mL者均显著多于观察2组，说明乙肝免疫球蛋白对乙肝疫苗免疫效应存在抑制现象。

Objective To study immunological effect and its duration of hepatitis B vaccine（HBvac） on those infants whose mother was hepatitis B virus carrier and to determine the repeat inoculation time of HBvac, and influence of hepatitis B immunoglobulin（HBIG） on the immunological effect. Methods The infants born in Beijing Haidian District Maternal and Child Health Hospital whose mothers had positive hepatitis B surface antigen were observed. All the infants had negative HBsAg and HBeAg at birth and were inoculated 10μg of HBvac at 0, 1,6 months after birth respectively. The infants and their mothers were randomly divided into observation groupl and observation group 2. The infants in the observation group 1 were not injected any HBIG, while those infants in the observation group 2 were injected 100 - 200U of HBIG within 24 hour after birth and the repeated injection of same dose of HBIG was conducted in the 15th - 30th days after birth. Thereafter, quantitative detection of protective antibody HBsAb and qualitative HBsAg and HBeAg detections in vein blood samples of the children were conductedat every full years old. Those children with quantitative HBsAb value less than 100mU/mL were inoculated 10μg of HBvac again. Results ① Of 316 children whose mother was hepatitis B virus carrier, the quantitative value of HBsAb of 162 children was more than 100mU/mL（ 162/316, 51.3% ） at full 1 year old; ②At full 2 years old, HBsAb quantitative value of only 26 children whose HBsAb quantitative value was more than 100mU/mL at full 1 year old and did not receive booster inoculation of HBvac, was still more than 100mU/mL（26/266, 9.8% ）, and there was a significant difference in number of the children with more than 100mU/mL of HBsAb（χ^2 = 113. 698, P = 0.000） ; ③In the observation groupl, 48 children had HBsAb quantitative value less than 100mU/mL （48/118, 40.7% ）and in the observation group2, 106 children had HBsAb quantitative value less than lOOmU/mL （ 106/198, 53.5% ）, and there was a significant difference between the two groups（χ^2 =4.892, P =0.027）. Conclusion ①For those infants whose mother was hepatitis B virus carrier, it is very necessary to establish long-term follow up mechanism after three times of inoculation of HBvac at 0, 1,6 months of age; ②The children whose HBsAb was insufficient should be inoculated HBvac repeatedly（ booster inoculation） ; ③The fact that the number of infants in the observation group 1 whose HBsAb quantitative value was more than 100mU/mL both at full 1 year old and full 2 years old is more than that in the observation group 2 suggests that HBIG has depressive effect on the immunological effect of HBvac.