302例乙型肝炎疫苗母婴阻断效果评价及影响因素分析

Evaluation on the blocking effect of hepatitis B vaccine on mother-to-infant transmission in 302 cases and analysis of influencing factors

目的评价湖北省现行乙型病毒性肝炎(乙肝)免疫策略阻断母婴传播的效果,探讨母婴阻断失败的机制和可能影响因素。方法采用多阶段随机抽样方法,在湖北省抽取2个县区,通过产科医院保健手册、新生儿保健记录或医院病案系统等资料,回顾性调查2012—2018年乙肝病毒(hepatitis B virus,HBV)表面抗原(HBsAg)阳性孕妇的孕产情况及其所生儿童的HBV感染情况。结果302位孕妇所生的新生儿中HBsAg阳性32例,乙肝母婴阻断成功率为89.45%,68.21%(206/302)在乡镇医院分娩,66.23%(200/302)为剖腹产,41.72%(126/302)为母乳喂养,乙肝病毒e抗原(HBeAg)阳性16.89%(51/302),抗HBe阳性41.06%(124/302),孕期接种免疫球蛋白(hepatitis B immunoglobulin,HBIG)3.31%(10/302),新生儿接种HBIG94.37%(285/302),日常生活采取保护措施84.11%(254/302)。logistic回归分析显示,乡镇医院(OR=2.82,P<0.05)、孕期HBeAg阳性(OR=8.68,P<0.05)、孕期接种HBIG(OR=12.62,P<0.05)是母婴阻断失败的危险因素;孕期抗HBe阳性(OR=0.22,P<0.05)、新生儿接种HBIG(OR=0.20,P<0.05)、日常生活采取保护措施(OR=0.28,P<0.05)是母婴阻断的保护因素。结论乡镇医院分娩、孕期HBeAg阳性孕妇更容易阻断失败。孕期接种HBIG不能降低阻断失败的风险。新生儿接种HBIG、孕期抗HBe阳性、日常生活采取保护措施可降低阻断失败的风险。

Objective To evaluate the effect of the current immunization strategy for hepatitis B virus(Hepatitis B)in blocking mother-to-infant transmission in Hubei Province,and to explore the mechanism and possible influencing factors of failure of mother-to-infant blockade.Methods A multi-stage random sampling method was used to select 2 counties or districts in Hubei Province.Through maternity hospital health handbook,neonatal health record or hospital medical record system,hepatitis B virus(HBV)surface antigen(HBsAg)-positive pregnant women in 2012-2018 years were included to retrospectively investigate their delivery status and the HBV infection status of their children.Results Among the 302 newborns,32 were positive for HBsAg,and the success rate of blockade of mother-to-infant transmission of hepatitis B was 89.45%.Further analysis showed that 68.21%(206/302)of newborns were delivered in township hospitals,66.23%(200/302)were delivered by caesarean section and 41.72%(126/302)were breastfed,while 16.89%(51/302)were positive for hepatitis B virus e antigen(HBeAg),and 41.06%(124/302)were positive for anti-HBe.The vaccination rate of hepatitis B immunoglobulin(HBIG)during pregnancy was 3.31%(10/302),and the newborn HBIG vaccination rate was 94.37%(285/302).There were 84.11%(254/302)of pregnant women taking protective measures in daily life.Logistic regression analysis showed that township hospitals(OR=2.82,P<0.05),HBeAg positivity during pregnancy(OR=8.68,P<0.05),and HBIG vaccination during pregnancy(OR=12.62,P<0.05)were risk factors for failure of mother-to-infant blockade,while anti-HBe positivity during pregnancy(OR=0.22,P<0.05),vaccination of newborns with HBIG(OR=0.20,P<0.05),and protective measures taken in daily life(OR=0.28,P<0.05)were protective factors for mother-toinfant interruption.Conclusion Deliveries in township hospitals and HBeAg-positivity during pregnancy are more likely to fail in blocking of mother-to-infant transmission of hepatitis B.HBIG vaccination during pregnancy does not reduce the risk of blockade failure.Neonatal HBIG vaccination,anti-HBe positivity during pregnancy,and protective measures in daily life can reduce the risk of blockade failure of mother-to-infant transmission of hepatitis B.