HBsAg携带母亲所生婴幼儿HBV标志物动态变化分析

The dynamic changes in serologic HBV markers in infants born by HBsAg-carrying mothers

目的了解HBsAg携带母亲所生婴幼儿经高效价免疫球蛋白(HBIG)和乙肝疫苗联合免疫后乙肝病毒血清标志物(HBVM)的动态变化及其临床和流行病学意义。方法对209例HBsAg携带母亲的213例婴幼儿(双胎4例)进行随访调查,分别于婴幼儿0、1、4、7、12、24、36月龄应用酶联免疫吸附试验(ELISA)检测其HBVM水平。结果随访婴幼儿182例,随访率达85.45%。婴幼儿出生时HBsAg阳性者13例,随访结束时除2例持续阳性外,余均阴转;出生时HBsAg阴性的169例婴幼儿未出现HBsAg阳转。HBsAg、HBeAg双阳性母亲所生新生儿HBeAg阳性率高达57.69%(30/52)。HBeAg阳性率变化趋势与HBsAg相似,7月龄以后仅2例HBsAg为阳性的婴幼儿HBeAg仍为阳性,余均转阴。HBsAg携带母亲所生婴幼儿出生时抗-HBs阳性率为6.70%(12/179),经HBIG和乙肝疫苗联合免疫后,抗-HBs阳性率1月龄就达82.46%(47/57),7月龄时上升为91.77%(145/158),36月龄维持在73.68%(28/38)。1月龄随访时婴幼儿抗-HBe阳性率为49.12%(28/57),抗-HBc阳性率100%(57/57),之后均逐渐阴转,抗-HBe到24月龄全部阴转;而抗-HBc阳性率7月龄时仍高达84.81%(134/158),到36月龄下降至21.05%(8/38)。结论 HB-sAg携带母亲所生婴幼儿经HBIG和乙肝疫苗联合免疫后免疫效果良好。HBsAg携带母亲血中的HBeAg、抗-HBe和抗-HBc均能通过胎盘从母亲传递给胎儿。

Objective To investigate the dynamic changes in hepatitis B virus serologic markers（HBVM） in infants born by HBsAg-carrying mothers,who were immunized with high-titer immunoglobulin（HTIG） and hepatitis B vaccine,and evaluate the clinical and epidemiological significance thereof.Methods Two hundred and nine HBsAg-carrying pregnant women and their 213 newborns（4 twins） were consecutively involved from Dec.2002 to Oct.2004,and followed up when infants were at 1,7,12,24 and 36 months of age.HBsAg,anti-HBs,HBeAg,anti-HBe and anti-HBc in neonatal sera were detected by ELISA.Results One hundred and eighty-two infants（85.45%） born of HBsAg-positive mothers were followed up.Of them 13 were HBsAg positive at birth.At the end of follow-up,all of them changed negative except two cases who were persistently positive for HBsAg.No one in 169 infants who were HBsAg-negative at birth changed to HBsAg-positive.About 57.69%（30/52） neonates born by both HBsAg and HBeAg positive mothers showed detectable levels of HBeAg.Similar to HBsAg,HBeAg was detectable in only 2 infants who were also HBsAg positive after 7 months of age,and all the other infants became HBeAg-negative.The anti-HBs positive rate of newborn infants of HBsAg-carrying mothers was 6.70%（12/179）.After immunizing by HTIG and hepatitis B vaccine,the anti-HBs positive rate reached 82.46%（47/57） at 1 month of age and 91.77%（145/158） at 7 month of age.73.68%（28/38） of infants aged of 36 months showed detectable levels of anti-HBs.The anti-HBe positive rate of infants aged 1 month was 49.12%（28/57）,and the anti-HBc positive rate was 100%（57/57）.All infants became anti-HBe-negative at age of 24 months.The anti-HBc positive rate was still 84.81%（134/158） at 7 months of age and decreased to 21.05%（8/38） at 36 months of age.Conclusions The efficacy of HTIG combining with hepatitis B vaccine is fine in high risk infants born by HBsAg positive mothers.HBeAg,anti-HBe and anti-HBc can pass through human placenta from mother to fetus passively.