联合免疫阻断乙肝病毒母婴传播儿童母乳喂养安全性调查

Safety of breast feeding in children after combined immunization to block mother-to-child transmission of hepatitis B virus

目的了解乙肝疫苗和乙肝免疫球蛋白(HBIG)联合免疫阻断乙型肝炎(HBV)儿童母乳喂养的安全性。方法运用回顾性流行病学调查方法,选取2005—2017年山东省寿光市二级医院住院分娩的HBsAg阳性母亲及所生儿童为研究对象,开展问卷调查并采集血清。以酶联免疫吸附试验法(ELISA)检测乙型肝炎病毒(HBV)血清学5项指标,检出儿童HBsAg阳性为阻断失败。结果共调查儿童1939人,年龄1.5~14岁、平均年龄5.02岁;母乳喂养1469人、人工喂养470人,检出HBsAg阳性55人、阻断失败率为2.84%;母亲HBeAg阳性的儿童,母乳喂养组(7.21%)和人工喂养组(8.47%)阻断失败率差异无统计学意义(χ^(2)=0.220,P>0.05);母亲HBeAg阴性的儿童,母乳喂养组(1.20%)和人工喂养组(3.76%)阻断失败率差异有统计学意义(χ^(2)=5.400,P<0.05)。结论HBV感染的母亲,无论是HBsAg单阳性,还是HBsAg和HBeAg双阳性,所生儿童在联合免疫阻断后母乳喂养均为安全。

Objective To understand the safety of breastfeeding in children after combined immunization and hepatitis B immunoglobulin(HBIG)for preventing mother-to-child transmission of hepatitis B(HBV).Methods The mothers with HBsAg-positive and their children born in the second class hospitals in Shouguang city during 2005—2017 were selected to be the study objects with retrospective epidemiological investigation method and to conduct questionnaires,and their sera were also collected.The enzyme-linked immunosorbent assay(ELISA)was taken for detecting 5 serological indicators of HBV,and the blocking was failure if HBsAg was positive in child.Results Totally 1939 children aged from 1.5-14 years were investigated,with mean age of 5.02 years.There were 1469 children breast feeding and 470 bottle feeding.Fifty-five children were detected positive of HBsAg,with the blocking failure rate of 2.84%.Out of the children whose mother were HBeAg positive,no statistical difference(χ^(2)=0.220,P>0.05)in blocking failure rate was found between breast feeding group(7.21%)and bottle feeding group(8.47%).And the difference in blocking failure rate was of no statistical difference(χ^(2)=5.400,P<0.05)between breast feeding group(1.20%)and bottle feeding group(3.76%)among the children whose mothers were HBeAg negative.Conclusions The breast feeding is safe in the children after combined immunization blocking,no matter only HBsAg is positive or both HBsAg and HBeAg are positive in their mothers with HBV infection.