接种乙型肝炎疫苗对儿童乙型肝炎病毒相关性肾炎患病的影响

Effect of hepatitis B vaccine immunization on HBV associated nephritis in children

目的 分析乙型肝炎疫苗计划免疫的实施对儿童乙型肝炎病毒相关性肾炎 (HBV GN)及膜性肾病 (MN)患病率的影响。方法 对我院 72 7例肾脏活检的肾脏病患儿进行分析。 ( 1)以 1992年 1月 1日为界分为A、B两组。A组 2 11例 :1979年 11月至 1991年 12月 ;B组 516例 :1992年 1月至2 0 0 2年 3月将B组按每两年为一组再分为 5组 (B1组～B5组 )。 ( 2 )根据每个患儿有无乙型肝炎疫苗接种史分为接种组和未接种组。结果 ( 1) 72 7例中符合HBV GN诊断标准的有 64例。A组 2 11例中HBV GN有 2 8例 ,B组 516例中HBV GN为 3 6例 ( χ2 =7 3 97,P <0 0 1) ;B1至B5 组的HBV GN患病情况依次为 13 0 4% ( 9/ 69) ,7 3 2 % ( 6/ 82 ) ,6 2 5% ( 4 / 64) ,4 88% ( 4 / 82 ) ,5 94% ( 13 / 2 19) ,有下降趋势。( 2 ) 72 7例中有 115例接种史不详。在接种组 2 3 1例中HBV GN仅 8例 ,而未接种组 3 81例中有HBV GN 48例 ( χ2 =14 44,P <0 0 0 1)。 ( 3 ) 72 7例中病理类型为MN的有 46例 ,均为HBV GN。接种组中MN仅 6例 ,未接种组中MN有 40例 ( χ2 =12 92 ,P <0 0 0 1)。 ( 4 ) 8例接种过疫苗仍然患HBV GN的患儿 ,均有血清学乙型肝炎病毒 (HBV)标志物异常。其中有 2例MN患儿的母亲有明确的乙型肝炎病毒感染证据。

Objective Hepatitis B has been extensively prevalent in China and hepatitis B virus associated nephritis (HBV GN) has been one of the common renal damages secondary to HBV infection in Chinese children Regular vaccination against hepatitis B has been carried out nation wide in China since January 1st, 1992 The present study was conducted to evaluate the effect of regular vaccination against hepatitis B virus on the incidence of childhood HBV GN and membranous nephropathy (MN) Methods Retrospective analysis on the results of renal biopsy in 727 patients (from Nov 1979 to March 2002) was carried out The patients were first divided into two groups according to the date when the patients were seen Group A patients were seen from Nov 1979 through Dec 1991; Group B patients were seen from Jan 1992 through March 2002 Group B patients were further divided into 5 subgroups (Group B 1 to B 5), with a 2 year interval after 1992 Secondly, each of these groups and subgroups were again divided into two groups, vaccinated and unvaccinated groups Results In 727 renal biopsies, 64 cases (8 80%) met HBV GN diagnostic criteria Twenty eight cases were diagnosed as HBV GN in Group A (211 cases), accounting for 13 27%, while there were 36 cases with HBV GN in 516 renal biopsies of Group B, accounting for 6 98% (χ 2=7 397 and P < 0 01) The frequency in Group B was significantly lower Prevalence rate (from Group A to Group B 5) was 13 3 %(28/211),13 0 %(9/69),7 3 %(6/82),6 3%(4/64),4 9%(4/82),5 9 %(13/219),respectively, which showed a tendency of decline. Only 8 cases of HBV GN occurred in vaccinated group (231 cases), accounting for 3 5 %, while 48 cases of HBV GN were seen in unvaccinated group (381 cases), accounting for 12 6 %(χ 2=14 44 and P <0 001), vaccination history was unknown in 115 of the 727 cases. In 727 renal biopsies, pathological type of 46 cases (6 3 %) was membranous nephropathy and all of them had HBV GN Six cases of MN occurred in vaccinated group, accounting for 2 60%, while 40 cases with membranous nephropathy were found in unvaccinated group, accounting for 10 5 % (χ 2 =12 92 and P < 0 001) On the other hand, in vaccinated group there still were 8 cases of HBV GN whose serum markers of HBV were positive Two of their mothers had apparent evidence of hepatitis B virus infection Conclusion The frequency of HBV GN has decreased significantly after vaccination against hepatitis B virus was routinely carried out since 1992; at the same time, childhood membranous nephropathy might be decreasing gradually, too The cause of individual cases of HBV GN who has be vaccinated was probably due to maternal infant transmission and immunization failure Attention should be paid to interruption of maternal infant transmission and serological follow up should be performed in high risk newborns after vaccination to further lower the incidence of hepatitis B virus associated nephritis