HBV阳性母亲不同剂量免疫接种对婴儿的免疫效应

Immunologic effects of different doses of HBvac and HBIG on infants whose mother is HBV carrier

目的探讨不同剂量乙肝疫苗和乙肝免疫球蛋白对母亲为乙型肝炎（乙肝）病毒携带者婴儿的免疫效应。方法将423例生后均为乙肝表面抗原和乙肝e抗原定性检测阴性的婴儿，随机分为10μg乙肝疫苗（A）组、小荆量（〈10μg）乙肝疫苗（B）组、100U乙肝免疫球蛋白（C）组、200U乙肝免疫球蛋白（D）组、E组为C组加D组。除B组外，其他4组婴儿生后均按0、1、6个月方案各接种乙肝疫苗10μg。C组和D组婴儿生后第1天各用乙肝免疫球蛋白100U和200U肌肉注射，15～30天后按原量重复1次。观察婴儿生后1岁时乙肝保护性抗体——乙肝表面抗体定量检测、乙肝表面抗原和乙肝e抗原定性检测。结果423例婴儿生后1岁时乙肝表面抗原和乙肝e抗原定性检测均为阴性。在A组131例婴儿中，有84例乙肝表面抗体〉100mU／mL，占64．1％；在B组41例婴儿中，有14例乙肝表面抗体〉100mU／mL，占34．1％，两组比较，=11．446，P=0．001。C组136例婴儿中，有74例乙肝表面抗体〉100mU／mL，占54．4％，与A组比较r=2．604，P=0．107。D组115例婴儿中，有55例乙肝表面抗体〉100mU／mL，占47．8％，与A组比较，=6．617，P=0．010。E组251例婴儿中，有129例乙肝表面抗体〉100mU／mL，占51．4％，与A组比较X2=5．653，P=0．010。结论乙肝疫苗10μg注射3次的免疫效应显著优于小剂量乙肝疫苗注射3次的免疫效应。100U乙肝免疫球蛋白组1岁时乙肝表面抗体高值率低于10μg乙肝疫苗组，但经比较无显著性差异，200U乙肝免疫球蛋白组1岁时乙肝表面抗体高值率明显低于10μg乙肝疫苗组，经比较有显著性差异。说明乙肝免疫球蛋白剂量越大对乙肝疫苗产生抗体抑制越明显。

Objective To investigate immunologic effects of different doses of hepatitis B vaccine （HBvac） and hepatitis B immunoglobulin （HBIG） on infants whose mother was hepatitis B virus （HBV） carrier. Methods 423 infants whose mothers were all HBV carriers and hepatitis B surface antigen （HBsAg） and hepatitis B e antigen （HBeAg） of them were negative were divided into 5 groups ： 10μg of HBvac group （ group A）, low dose HBvac group（ 〈 10μg of HBvac） （ group B）, 100U of HBIG group （ group C）, 200μg of HBIG group （ group D） and 100 ＋200U of HBIG group （group E, combination of group C and group D）. Except those infants in the group B （less than 10μg of HBvac）, all infants in other 4 groups were inoculated 10μg of HBvac at 0,1,6 month after birth. Those infants in the group B were inoculated lesser than 10μg of HBvac every times. The infants in group C and group D were injected 100U or 200U of HBIG within 24 hours after birth respectively and same dose of HBIG injection was repeated at 2 ~ 4 weeks after birth. At full 1 year of age, quantitative protective antibody--hepatitis B surface antibody （HBsAb） and qualitative HBsAg and HBeAg of the infants were tested. Results At full 1 year of age, qualitative HBsAg and HBeAg of all 423 infants were negative. In the group A, quantitative HBsAb of 84/131infants was greater than 100mU/mL（64. 1% ）, and in the group B, that of 14/41 infants was greater than 100mU/mL （34. 1% ）, there was a significant difference between the two groups（x2 = 11. 446, P = O. 001 ）. In the group C, quantitative HBsAb of 74/136 infants was greater than 100mU/mL（54.4% ）, and there was a significant difference as compared with group A （X2 = 2.604,P = 0. 107）. In the group D, quantitative HBsAb of 55/115 infants was greater than 100mU/mL （47.8%） and there was a significant difference as compared with group A （X2 = 6.617, P = 0.010）. In the group E, quantitative HBsAb of 129/251 infants was greater than 100mU/mL （51.4% ） and there was a significant difference as compared with group A （X2 =5. 653 ,P =0.010）. Conclusion The immunologic effect of 10μg of HBvac 3 times injection is significantly better than that of low dose HBvac 3 times injection. The high HBsAb value rate of the infants at full 1 year of age in the group C was lower than that in the group A, but the difference was not significant. While the high HBsAb value rate of the infants at full 1 year of age was significantly lower than that in the group A and the difference was significant. This suggested that the greater the dose of HBIG, the more significant of restaining for producing HBsAb after inoculating HBvac.