上海市浦东新区乙型肝炎病毒母婴传播的发生率及其影响因素研究

Incidence of mother to child transmission of hepatitis B virus and its influencing factors in Pudong New Area of Shanghai

目的研究乙型肝炎病毒(HBV)母婴传播情况及其影响因素,为乙肝防治工作提供依据。方法从上海市浦东新区4家医疗机构中招募445名HBV表面抗原(HBsAg)阳性产妇开展流行病学问卷调查,分别采集母亲外周血和新生儿脐带血检测乙肝血清学指标及HBV DNA滴度。新生儿脐带血HBsAg阳性与HBV DNA阳性者定义为新生儿HBV阳性。新生儿均按国家规定注射疫苗,对104名新生儿开展出生后随访到7月龄,采集血样进行乙肝血清学与HBV DNA滴度检测,7月龄婴儿HBsAg阳性定义为儿童HBV突破免疫感染。结果 HBsAg阳性产妇所生新生儿HBV阳性率为8.0%。HBsAg和HBV e抗原(HBeAg)双阳性产妇的新生儿HBV阳性率高于HBsAg单阳性产妇的新生儿(26.7%vs 1.8%,P<0.05);HBV DNA大于106copies/mL产妇的新生儿HBV阳性率高于HBV DNA小于106copies/mL产妇的新生儿(23.6%vs 2.3%,P<0.05)。产后7个月,婴儿突破免疫感染率为3.8%,其母亲均为HBsAg和HBeAg双阳性者。结论母体HBeAg阳性与HBV DNA高浓度是新生儿HBV阳性的主要危险因素,并可能导致新生儿免疫失败。

Objective To study the transmission of hepatitis B virus （HBV） from mother to child and the related influencing factors, so as to provide evidence for HBV control. Methods An epidemiological survey was conducted on 445 motherqnfant pair participants with positive maternal HBsAg from 4 hospitals in Pudong New area of Shanghai. Peripheral blood samples of mothers and the umbilical cord blood samples of the infants were collected to detect the markers and DNA titer of HBV. HBsAg positive and HBV DNA positive in umbilical cord blood were defined as HBV positive in the infants. All the newborns received vaccination after birth according to the national regulation. Of the 445 participants, 104 newborns were followed for 7 months after birth, and the blood samples were collected and the markers and DNA titer of HBV were examined. HBsAg positive after 7 months was defined as immune failure. Results The positive rate of HBV in the newborns was 8.0% for mothers with positive HBsAg in our study. The HBV positive rate of newborns whose mothers were positive for both HBsAg and HBeAg was significantly higher than whose mothers were only HBsAg positive （26.70//oo vs 1.8~, P^0.05）. The HBV positive rate was significantly higher in newborns whose mothers with HBV DNA ~106 copies/mL compared with those with HBV DNA ~106 copies/mL （23.6% vs 2.3%, P〈0.05）. The immune failure rate of hepatitis B vaccine was 3.8% 7 months after birth in our study, with all their mothers being positive for both HBsAg and HBeAg. Conclusion The maternal HBeAg positivity and the high concentration of HBV DNA are the main risk factors of neonatal infection, and they may lead to non-response to hepatitis B vaccine.