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HBV母婴传播阻断效果及影响因素分析
Blocking effects on and influencing factors for mother-to-infant transmission of hepatitis B virus: a study in Changchun, China
文章发布日期:2015年07月08日  来源:  作者:王川,武兴,王崇,等  点击次数:1527次  下载次数:313次

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【摘要】:目的 评价应用不同剂量乙型肝炎疫苗(HepB)联合乙型肝炎免疫球蛋白(HBIG)阻断HBV母婴传播的效果及HBV母婴传播的影响因素。方法 选取2012年7月-2015年2月在吉林大学第一医院进行HBV母婴阻断的785对乙型肝炎孕妇及其新生儿作为研究对象,根据孕妇产前HBV血清学标志物检查结果,对HBsAg单阳性、HBsAg与 HBeAg双阳性母亲的新生儿制订不同剂量阻断方案,在出生后2 h内分别注射10 μg或20 μg HepB联合100 IU HBIG,并于1、6月龄继续接种HepB。对入组孕妇及婴儿进行长期随访,采集婴儿7和12月龄静脉血检测HBV血清学标志物。计数资料组间比较采用χ2检验或Fisher确切概率法,组间HBV DVA的比较经对数转换后采用Mann-Whitney U秩和检验。探讨HBV相关因素采用非条件Logistic回归分析,并做影响HBV母婴传播的多因素分析。结果 785例新生儿中,HBsAg阳性但HBeAg阴性的529名孕妇所生的新生婴儿无一感染,阻断成功率为100%;256例HBsAg与HBeAg双阳性孕妇所生新生儿中,有14例婴儿感染,阻断成功率为94.53%。母亲HBeAg阳性、HBV DNA>108 IU/ml与阻断失败密切相关(P<0.001)。本研究未发现母亲的分娩方式、新生儿喂养方式等因素与阻断失败有关。探讨干预依从性时发现,首针疫苗未得到及时足量注射的新生儿更易发生感染。进一步Logistic回归分析发现,母亲HBV DNA>108 IU/ml、首针疫苗未及时或未足量接种及男性婴儿更易发生HBV母婴传播。结论 HBsAg阳性母亲的新生儿经过联合免疫后,可有效提高HBV母婴阻断成功率。母亲的感染状态、病毒载量和首针疫苗注射情况是影响HBV母婴传播阻断成功与否的决定性因素。
【Abstract】:ObjectiveTo study the blocking effects of different concentrations of hepatitis B vaccine (HepB) combined with hepatitis B immune globulin (HBIG) on mother-to-infant transmission of hepatitis B virus (HBV) and the influencing factors for mother-to-infant transmission of HBV. MethodsA total of 785 pregnant women with hepatitis B and their infants who received interruption of mother-to-infant transmission of HBV in our hospital from July 2012 to February 2015 were enrolled as subjects. According to the results of prenatal examination of serum HBV markers in pregnant women, blocking regimens with different doses were made for infants born to HBsAg-positive/HBeAg-negative and HBsAg-positive/HBeAg-positive mothers, who received 10 μg and 20 μg HepB, respectively, combined with 100 IU HBIG by injection within 2 hours after birth, and were vaccinated with HepB again at 1 and 6 months after birth. A long-term follow-up was performed in pregnant women and infants, and the venous blood of infants was collected at 7 and 12 months after birth for evaluation of serum HBV markers. ResultsIn the 785 infants, none of the infants born to the 529 HBsAg-positive/HBeAg-negative mothers were infected, suggesting a blocking rate of 100%, while 14 out of 256 infants born to HBsAg-positive/HBeAg-positive mothers were infected, yielding a blocking rate of 94.53%. The positive HBeAg and a HBV DNA level higher than 108 IU/ml were significantly correlated with blocking failure (P<0.001), while other factors including childbirth and feeding methods were not found correlated with blocking failure in this study. The investigation of intervention for compliance revealed that infants who were not given timely or full-dose injection for the firstvaccination were more likely to be infected. Further logistic regression analysis showed that the incidence of mother-to-infant transmission of HBV was higher in infants born to mothers with a HBV DNA level higher than 108 IU/ml, infants who were not given timely or full-dose injection for the first vaccination, and male infants. ConclusionCombination vaccination can effectively increase the blocking rate of mother-to-infant transmission of HBV in infants born to HBsAg-positive mothers. The infection status of mother, viral load, and first vaccination are key factors for blocking mother-to-infant transmission of HBV.
【关键字】:肝炎病毒,乙型;疾病传播,垂直;免疫接种,加强
【Key words】:hepatitis B virus; disease transmission, vertical; immunization, secondary
【引证本文】:王川, 武兴, 王崇, 等. HBV母婴传播阻断效果及影响因素分析[J]. 临床肝胆病杂志, 2015, 31(8): 1238-1243.

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