2021年河南省某监测点178例乙型肝炎病毒表面抗原阳性孕妇母婴阻断效果及影响因素

Mother-to-child transmission blocking and its influencing factors in 178 cases of HBsAg positive pregnant women at a monitoring site in Henan Province in 2021

目的开展乙型肝炎病毒表面抗原(HBs Ag)阳性母亲所产新生儿接种乙肝疫苗(Hep B)和乙肝免疫球蛋白(HBIG)后血清学监测(PVST),评价其母婴阻断效果;为免疫失败的易感儿童再次接种乙肝疫苗,以降低新生儿乙型肝炎病毒(HBV)感染风险。方法2021年,在周口市淮阳区国家PVST监测点,以HBs Ag阳性母亲及其所产的新生儿为研究对象,全程接种乙肝疫苗和乙肝免疫球蛋白后1~2个月,采集静脉血开展HBs Ag和乙肝病毒表面抗体(抗-HBs)检测,并对HBs Ag阴性且抗-HBs阴性的易感儿童进行乙肝疫苗的再次免疫。结果本研究共纳入178例HBs Ag阳性母亲所产的新生儿,乙肝疫苗全程接种率、及时接种率、乙肝免疫球蛋白接种率均为100.0%;阻断成功174例,成功率97.8%。发现易感儿童36例,对其再次进行免疫,其中18例血清标本进行检测,全部产生了保护性抗体;18例未采集血清标本,其中7例完成了全程免疫,11例未完成。HBs Ag单阳性组和HBs Ag、HBe Ag双阳性组的母婴阻断成功率分别为99.2%和93.6%,差异有统计学意义(Fisher确切概率法,P<0.05);母亲不同分娩年龄、文化程度、肝炎病程、分娩方式,HBV母婴传播阻断成功率差异无统计学意义(χ^(2)值分别为0.07、0.07、2.67、0.35,P均>0.05);儿童不同性别、胎龄、体重、胎次,HBV母婴传播阻断成功率差异无统计学意义(χ^(2)值分别为0.69、0.48、0.00、1.10,P均>0.05)。结论对HBs Ag阳性母亲所产新生儿实施Hep B和HBIG联合免疫且开展抗体水平监测可及时发现易感儿童,进行再次免疫可提高阻断成功率。

Objective To conduct post-vaccination serological test(PVST)on newborns born to mothers for hepatitis B virus surface antigen(HBs Ag)positive after immunized with hepatitis Bvaccine(Hep B)and hepatitis Bimmunoglobulin(HBIG),toevaluate the effectiveness of mother-to-child transmission blocking of the treatment.Non-responsive babies were re-vaccinated with the hepatitis B vaccine,aiming to reduce the risk of neonatal HBV infection.Methods Newborns born to HBs Ag-positive mothers in Huaiyang District,a national PVST monitoring site in Zhoukou City,Henan Province in 2021,were selected as study objects.Blood samples were collected for antibody monitoring within 1-2 months after immunized with hepatitis B vaccine and hepatitis B immunoglobulin concurrently.Babies with HBs Ag negative and anti-HBS negative were re-immunized with hepatitis B vaccine.Results A total of 178 subjects were included in the study.All newborns were immunized with Hep B and HBIG timely.Successful blocking was achieved in 174 cases,resulting in a 97.8%success rate.Among 36 susceptible children identified,18completed the re-immunization and all protective antibodies,yielding a 100.0%re-immunization success rate.No specimens were collected from18 newborns.Among them,7 completed the immunization and 11 did not.The success rate of mother-to-child blocking was significantly higher in HBs Ag group(99.2%)than in the HBs Ag+HBe Ag group(93.6%)(P<0.05).No significant differences were observed in success blocking rates across different maternal ages,education levels,courses of hepatitis,or delivery modes(χ^(2)=0.07,0.07,2.67,0.35,P>0.05).Similarly,no significant differences were found among children of different sexes,gestational age,parities and weight(χ^(2)=0.69,0.48,0.00,1.10,P>0.05).Conclusions For newborns born to HBs Ag positive mothers,the combination of Hep B and HBIG immunization and antibody level monitoring can effectively identify and re-immunize susceptible children,thereby improving the success rate of blocking immunization.