乙型肝炎病毒感染母亲的新生儿免疫预防远期保护效果

Long - term protection of infants against hepatitis B by neonatal immunoprophylaxis born from mothers infec- ted with hepatitis B virus

目的观察乙型肝炎病毒（HBV）感染母亲的新生儿免疫预防后远期保护效果，探讨是否需要加强接种乙型肝炎（乙肝）疫苗。方法2017年7月至9月邀请2012年在南京鼓楼医院随访过的252例出生于HBV感染母亲但乙肝表面抗原（HBsAg）阴性的子女进行再次随访，记录加强接种乙肝疫苗情况和相应病史，并采血检测HBV血清标志物。结果252例儿童中实际随访198例（78.6%），年龄（8.4±2.2）岁，其中男童112例。所有儿童HBsAg和乙肝核心抗体（抗－HBc）均阴性，乙肝表面抗体（抗－HBs）阳性（≥10 IU/L）率为65.7%。53例儿童加强接种乙肝疫苗，抗－HBs中位浓度由158.01 IU/L升至327.95 IU/L，差异有统计学意义（Z＝－4.480，P〈0.05）；抗－HBs阳性率由45.3%升至90.6%，差异有统计学意义（χ2＝24.941，P〈0.05）。145例未加强接种儿童，抗体中位浓度（214.19 IU/L比70.49 IU/L，Z＝－6.575，P〈0.05）和抗－HBs阳性率（82.8%比56.6%，χ2＝23.558，P〈0.05）较前下降。145例未加强接种儿童中，2012年抗－HBs〈10 IU/L有25例，另120例抗－HBs ≥10 IU/L，2017年随访时47例（39.2%）抗－HBs转阴。结论HBV感染母亲的子女新生儿期接种乙肝疫苗后有免疫应答者具有远期保护效果，即使抗－HBs〈10 IU/L，对乙肝仍然具有免疫力，无需加强接种乙肝疫苗。

Objective To evaluate the long-term efficacy of neonatal immunoprophylaxis in children born from mothers infected with hepatitis B virus （HBV）, and to clarify whether a booster vaccination is required.Methods Totally 252 children of HBV infected mothers, who were negative for hepatitis B surface antigen （HBsAg） tested in Nanjing Drum Tower Hospital in 2012, were enrolled to participate in this study from July to September, 2017.Revaccination of hepatitis B vaccine was recorded and other relevant informations were collected.HBV serologic markers were detected in each child.Results Totally 198 children （78.6%） were followed up.They were （8.4±2.2）years old and 112 cases were boys.All 198 children were negative for both HBsAg and hepatitis B core antibody （anti-HBc）. The overall positive rate of hepatitis B surface antibody （anti-HBs） （≥10 IU/L） was 65.7%.During period of 2012 to 2017, 53 children were boosted with hepatitis B vaccine.Their median anti-HBs titer in 2017 was higher than that in 2012 （327.95 IU/L vs.158.01 IU/L）, and the difference was significant （Z=-4.480, P〈0.05）. The other 145 children were not revaccinated, their median anti-HBs titer was decreased from 214.19 IU/L in 2012 to 70.49 IU/L in 2017, and the difference was significant （Z=-6.575, P〈0.05）. Of 145 children who were not revaccinated, 25 cases had anti-HBs levels 〈10 IU/L and 120 cases ≥10 IU/L in 2012, and the other 47 cases also showed the antibody 〈10 IU/L in 2017, but none of them was infected with HBV.Conclusions Neonatal immunoprophylaxis in infants from HBV-infected can provide long-term protection against hepatitis B. The children with anti-HBs 〈10 IU/L are still immune to HBV and booster vaccination for them seems unnecessary.