扬州市部分全程联合免疫阻断乙肝母婴传播效果评价

Evaluation on effect of combined immunization in blocking mother-to-child transmission of hepatitis B,Yangzhou city

目的了解乙肝表面抗原阳性孕妇所生新生儿联合应用乙型肝炎免疫球蛋白(HBIG)和乙型肝炎疫苗阻断母婴传播的效果。方法收集扬州市妇幼保健院2015~2016年578例HBsAg阳性孕产妇的资料,按"两对半"检测结果分组,"HBsAg阳性、HBeAg阴性"为单阳组,"HBsAg阳性、HBeAg阳性"为双阳组,两组孕产妇所生新生儿生后均即刻注射HBIG100国际单位,并按照《预防接种规范》中新生儿乙肝疫苗免疫程序,完成3剂次乙肝疫苗接种。在完成第3剂次乙肝疫苗接种后,即儿童7月龄召回检测"两对半",判断有无感染或有无免疫力。结果 578名婴儿中1例HBsAg阳性,母婴阻断失败率0.17%;女婴抗-HBs≥100mlU/ml明显高于男婴(P<0.05),全程免疫对单阳组孕妇的婴儿保护率100%,双阳组孕妇的婴儿保护率99.57%。多因素分析发现,母亲HBsAg阳性、HBeAg阴性(OR=2.35,P<0.01),出生体重为2 000~4 000g(OR=12.63,P<0.01)的婴儿免疫应答更好。结论全程联合免疫阻断乙肝母婴传播效果理想,但HBsAg阳性、HBeAg阳性母亲所娩婴儿较HBsAg阳性、HBeAg阴性略差。

Objective To understand the effect of combining application of HBIG and HBV vaccines to infant whose mother with HBsAg-positive to block mother-to-child transmission. Methods Data of 578 HBsAg-positive mothers and their children were collected from January 2015 to December 2016 in Yangzhou City Maternal and Child Health Care Hospital.The testing results of hepatitis B in half were divided into two groups.The results with HBsAg positive and HBeAg negative were divided into single positive group.The results with HBsAg and HBeAg both positive were divided into double positive group.Both groups of newborn babies were injected with HBIG100 international units immediately after birth and in accordance with the immunization procedure of neonatal HBV vaccine completed three doses of HBV vaccine.After the completion of the third dose of hepatitis B vaccine,the children＇s 7 months recall test hepatitis B in half,to determine whether there was infection or whether there was immunity. Results The failure rate of the mothers HBsAg positive group was 0.17%（1/578）.The baby girl＇s normal response was significantly higher than that of the baby boy（P0.05）.The protective rate of combined immunization in the child whose mother with HBsAg-positive was 100%.The protective rate of combined immunization in the child whose mother with HBsAg and HBeAg positive were both positive was 99.57%.Multifactorial analysis found that the infant＇s immune response was better at birth weight between 2 000 g-4 000 g and whose mother with HBsAg-positive than other groups. Conclusion The effect of combined immunization block of the mother-to-child transmission is ideal,but the effect of the baby＇s blocking whose mother with HBsAg-positive is a little worse than whose mother with both HBsAg and HBeAg positive.