新生儿不同时期静脉血HBsAg含量对HBV母婴传播阻断失败的预测研究

Predictive study of HBsAg in different stages of neonatal venous blood on failure of blocking HBV mother to infant transmission

目的探讨HBV慢性感染孕妇新生儿出生后不同时期静脉血HBsAg含量变化对ItBV母婴传播阻断失败的预测价值。方法以HBsAg、HBeAg双阳性、血清HBVDNA含量≥10^5拷贝／ml慢性HBV感染孕妇所娩新生儿150例为研究对象，出生后立即注射乙肝免疫球蛋白200Iu，并按0、1和6个月程序接种乙肝疫苗10～20μg。分别于新生儿出生时、生后1个月、生后7个月采取静脉血检测HBV血清学指标，分析新生儿不同时期静脉血HBsAg含量对HBV母婴传播阻断失败的预测。结果共有11例新生儿发生HBV母婴阻断失败。新生儿出生时、生后1个月、生后7个月HBsAg阳性率分别为41．26％、10．49％、7．69％，HBeAg阳性率分别为97．90％、65．75％、13．29％。以出生时I-IBsAg≥O．05和HBsAg≥1IU／ml预测HBV母婴传播阻断失败，阳性预测价值分别为18．64％和70％；生后1个月HBsAg〉~O．05和HBsAg≥1IU／ml的阳性预测价值分别为73．33％和100％。结论出生时静脉血HBsAg含量≥1IU／ml时应高度怀疑HBV母婴传播的失败。生后1个月HBsAg≥1IU／ml对母婴传播阻断失败有高度的预测价值，如何提高出生时和生后1个月静脉血HBsAg阳性新生儿的HBV感染阻断率是以后研究的重点。

Objective In this study, we discuss the predictive value of different content of HBsAg in different stages of neotal venous blood on failure of blocking mother to infant transmission of HBV. Methods 150 infants born of chronically HBV infected mothers who were positive of both HBsAg and HBeAg and who also had a HBV DNA virus load above 105 copies/ml were enrolled. These infants were given hepatitis B virus immune globin（HBIG） 200 IU immediately after birth and were given hepatitis B vaccine 10 or 20 μg at brith, 1 month and 6 months after birth. HBV serological index of these infants were test at birth, 1 month and 7 months after birth respectively. Different content of HBsAg in different stages of neonatal venus blood were analyzed to predict the failure of blocking mother to infant transmission of HBV. Results 11 infants failed in blocking of HBV mother to infant transmission. The positive rate of HBsAg at birth, 1 month and 7 months after birth were 41.26%, 10.49% and 7.69% respectively, and were 97.90% ,65.73% and 13.29% of HBeAg. The positive predictive value of HBsAg≥0.05 and HBsAg≥ 1 IU/ml at birth were 18.64% and 70% respectively, and were 73.33% and 100% one month after birth. Conclusions Infants with HBsAg≥ 1 IU/ml at birth should be suspicious of failure on blocking HBVmother-to-infant transmission and it should be more credible if the infant has HBsAg ≥ 1 IU/ml one month after birth. How to improve the blocking rate of neonates who were positive of HBsAg at birth and one month after birth should be the focus of our future research.