新生儿乙型肝炎病毒血清标志物检测及其转归

Determination and seroconversion of hepatitis B markers in the newborn of hepatitis B virus carrier mothers

目的探讨乙型肝炎病毒携带产妇所生新生儿血清乙型肝炎病毒标志物(HBV-M)转归。方法2001年3月至2006年3月在暨南大学附属第一医院进行产前检查的500例HBsAg阳性产妇所生新生儿,根据母亲HBeAg状态分为HBeAg阳性组144例,HBeAg阴性组356例。两组新生儿在出生12h内均注射乙型肝炎免疫球蛋白100IU,并按常规0、1、6方案分别在出生时、1月龄和6月龄注射基因重组乙型肝炎疫苗5μg,注射主被动免疫前分别抽取外周静脉血检测HBV-M。结果两组新生儿出生时外周血HBsAg、HBeAg均阳性者分别为24例和9例,追踪至6月龄时HBsAg阳性例数分别为10例和5例,HBsAg阴转率差异无统计学意义。两组新生儿出生时HBsAg阳性、HBeAg阴性者分别为4例和21例,追踪至6月龄时,HBsAg阴转率分别为100%和85.7%。出生时HBsAg阴性、HBeAg阳性者,HBeAg阳性组为29例,占20.1%,显著高于HBeAg阴性组比例(P<0.01),其6月龄HBsAg阳转率为6.9%,明显低于HBeAg阴性组(P<0.01)。在接受全程主被动免疫的情况下,HBeAg阳性组新生儿6月龄HBsAg和HBsAb阳性率分别为9.7%和67.4%,HBeAg阴性组分别为3.1%和78.1%,两组比较差异有统计学意义(P<0.05)。结论新生儿出生时外周血HBsAg阳性不能作为判断宫内感染的指标,HBeAg阳性新生儿预后与母亲HBeAg状态密切相关,母亲HBeAg阳性会抑制新生儿对乙型肝炎疫苗的反应。

Objective To explore the seroeonversion of hepatitis B markers in the neonates born to hepatitis B carrier women. Methods A total of 500 neonates horn to the women positive for hepatitis B surface antigens （ HBsAg） were recruited. Depending on the hepatitis B e-antigens （ HBeAg ） status of their mothers, they were divided into two groups. Group A had 144 eases, the serum HBeAg of their mother was positive, and Group B had 356 eases, the serum HBeAg being negative. All neonates received 100IU HBIG within 12 h of birth and followed by 3 doses 5μg hepatitis B vaccination at birth and at the age of one and six months schedule. The hepatitis B serologic markers of infants were followed up at birth and at the age of one and six months. Results There were 24 and 9 neonates in group A and B respectively with serum HB- sAg（ ＋ ） and HBeAg（ ＋ ） at birth. After six months of follow-up,there were 10 cases in Group A and 5 cases in Group B with HBsAg positive constantly. There were no significant difference between Group A and B in the HbsAg conversion rate,4 and 21 neonates in Group A and B respectively with serum HBsAg （ ＋ ） and HBeAg（ - ） at birth. Of them, the seroconversion rate to HBsAg negativity was 100% and 85.7% in Group A and B respectively at six months visit. No significant difference was found between two groups. There were 29 infants in Group A tested HBsAg（ - ）/HBeAg（ ＋ ）at birth, it was significantly higher than the rate of Group B （29/144 vs 3/356） , P. 〈 0.01. Of them, the neonatal seroconversion rate to HBsAg positivity at six months of age was 6.9% and 100% respectively in Group A and B, the difference being significant between two groups, P = 0. 037. There were 87 infants in Group A and 323 infants in Group B tested HBsAg （ - ）/HBeAg（ - ）at birth. Of them 2 cases and no cases in Group A and B tested positive for HBsAg at the 6- month visit. No significant difference was found in their seroconversion rate to HBsAg positive. Conclusion Neonates would not be diagnosed as intrauterine infection of HBV when their serum HBsAg was positive at birth. The prognosis of neonates with HBeAg-positive at birth correlats with their maternal HBeAg status.