母婴阻断成功儿童1岁至3岁乙肝表面抗体的保护性研究

Protectivity of hepatitis B surface antibody in children between 1 and 3 years after successful blocking of mother-to-child transmission

目的 探讨高病毒载量e抗原（HBeAg）阳性慢乙肝孕妇母婴阻断成功后,在1岁和3岁之间儿童HBsAb滴度变化以及分析其长期保护性和感染率.方法 入组乙肝表面抗原（HBsAg）、HBeAg双阳性、孕28周HBV DNA≥106IU/ml慢性HBV感染孕妇的1周岁龄儿童,并随访至3岁,分别在1岁和3岁时检测这些儿童的进口乙肝五项及生化检测并分析1岁至3岁未补打加强疫苗儿童HBsAb滴度变化、阳性率、阴性率和感染率;同时回顾性收集这些1岁儿童在我院有7个月HBsAb滴度检测者,分析7个月至1岁期间未补打加强疫苗儿童HBsAb滴度变化、阳性率和阴性率.结果 该研究入组264例1岁儿童,其中有7个月至1岁期间未补打加强疫苗儿童有178例,1岁至3岁期间的儿童中有114例未补打加强疫苗.结果显示在l岁和3岁时未发现感染儿童.7个月至1岁儿童HBsAb滴度呈现下降趋势,HBsAb滴度中位数从1 000 IU/L降至509.43 IU/L（P＜0.05）,抗体仍然具有保护性;而1岁至3岁期间,HBsAb滴度中位数从466.72 IU/L降至67.3 IU/L （P＜0.05）,3岁时有60.52％儿童处于低免疫应答或无应答状态,但仍具有保护性,但显著低于补打加强疫苗者,因此,这些1岁至3岁期间未补打加强疫苗的儿童仍处于高危状态.结论 7个月抗体有保护性,则1岁和3岁时不易感染;而3岁时抗体降至低或无应答状态,儿童仍处于高危状态,有必要对其采取保护措施,补打加强疫苗.

Objective To investigate the change of hepatitis B surface antibody （HBsAb） titer and its long-term protection and infection rates between 1 and 3-year-old children whose mothers were chronic hepatitis B pregnant woman with HBeAg positive and high viral load after successful blocking of mother-to-child transmission.Methods One-year-old children whose mothers were hepatitis B surface antigen （HBsAg） and hepatitis B e antigen （HBeAg） positive,with HBV DNA ≥ 106IU/ml were enrolled,then were followed up till 3 years old,and tested the five serological markers of hepatitis B and biochemical parameters at the age of one and three years respectively,and analyzed HBsAb titer,positive rate,negative rate and infection rate of 1 to 3-year-old children without enhanced vaccination;meanwhile,data of HBsAb titers at the age of 7 months were collected HBsAb titer,positive rate,and negative rate were analyzed.Results Totally 264 1-year-old children were enrolled into the study,including 178 children without enhanced vaccination between seven months and 1 year of age,and 114 children without enhanced vaccination between 1 year and 3 years of age.Our result showed that there were no infected children at the age between 1 and 3 years.HBsAb titer decreased from 7 months to 1 year old and dropped from 1 000 IU/L to 509.43 IU/L （P 〈 0.05）,and the antibody was still protective.From 1 year to 3 years old,HBsAb titer dropped from 466.72 IU/L to 67.3 IU/L （P 〈 0.05）;at the age of 3 years,60.52 % children were either weakly positive or negative,but still protective,but significantly less than those who had the reinforced vaccination.As a result,the children without the enhanced vaccination between 1 and 3 years of age were still at high risk.Conclusions If the antibody was protective at 7 months,children were not easily infected between-1 year and 3 years of age.At the age of 3,the antibody dropped to low or no responsive levels,and the children were still at high risk.It is necessary to take protective measures and supplement the vaccine.