摘要
目的了解泉州市HBsAg阳性产妇所生儿童的乙肝免疫状况,评价本市乙肝母婴阻断方案的保护效果,并分析免疫失败的流行特征。方法通过问卷调查,收集整理泉州市惠安、石狮两县HBsAg阳性产妇及其新生儿基本信息,在新生儿完成3针乙肝疫苗接种后1~2月,采集血标本并通过胶体金法检测HBsAg、抗HBs。结果HBsAg阳性产妇所生儿童经乙肝疫苗和乙肝免疫球蛋白(HBIG)联合免疫后,其抗-HBs阳性率为93.1%,HBsAg阳性率为1.8%,免疫失败率为6.9%。新生儿乙肝免疫失败与HBsAg阳性产妇谷丙转氨酶(ALT)值和HBV-DNA值高低、产妇HBeAg阳性与否有关(P<0.05),ALT、HBV-DNA值越高,免疫失败的概率越大,HBeAg阳性产妇所生新生儿免疫失败率高于HBeAg阴性;乙肝母婴阻断与HBsAg阳性产妇ALT值和HBV-DNA值高低有关(P<0.05),ALT、HBV-DNA值越高,母婴阻断失败的概率越大。HBV-DNA≥104 cps/mL HBsAg阳性产妇选择20μg/mL乙肝疫苗和200 IU HBIG进行接种的率明显高于HBV-DNA<104 cps/mL产妇。结论泉州市现行乙肝母婴阻断策略实施效果较好,建议HBeAg阳性且HBV DNA载量>6 log10 IU/mL的母亲在孕期进行干预治疗,以进一步减少免疫失败率,提高母婴阻断率。
Objective To explorethe status of hepatitis B immunization in children born to HBsAg-positive mothers in Quanzhou City,and evaluate the effects on blocking HBV maternal-neonatal transmission,and analyze the epidemiological characteristics of neonatal immunoprophylaxis failure.Methods A questionnaire survey was conducted to collect the information of HBsAg-positive mothers and their neonates in Hui'an and Shishi counties of Quanzhou City.Venous blood samples were collected from the infants after 1-2 months when they completed 3 doses of hepatitis B vaccine,and serum HBsAg,anti-HBs were detected by colloidal gold method.Results The anti-HBs positive rate and HBsAg-positive rate of infants were respectively 93.1%and 1.8%.The infants'immunoprophylaxis failure rate was 6.9%,which was associated with ALT,HBV-DNA values and HBeAg status of mothers(P<0.05).The higher the ALT and HBV-DNA values was,the greater probability of immunoprophylaxis failure was.The neonatal immune failure rate of HBeAg-positive mothers was significantly higher than that of HBeAg-negative.Blocking mother-to-infant transmission of HBV was associated with ALT and HBV-DNA values in HBsAg-positive women(P<0.05).The higher the ALT and HBV-DNA values was,the greater probability of maternal-infant block failure.The 20μg/mL hepatitis B vaccine and 200 IU HBIG vaccination rate in children whose mother's HBV-DNA≥104 cps/mL was significantly higher than whom of HBV-DNA<104 cps/mL.Conclusion The current immunological strategy in Quanzhou has well protective efficacy for the interruption of HBV mother-to-infant transmission.It is recommended that mothers with HBeAg-positive and HBV DNA>6 log10 IU/mL should be intervented during pregnancy to further reduce the rate of immunoprophylaxis failure and increase the blockage of HBV maternal-neonatal transmission.
作者
黄彩虹
曾珊珊
陈小平
HUANG Caihong;ZENG Shanshan;CHEN Xiaoping(Quanzhou City Center for Disease Control and Prevention,Quanzhou,Fujian 362000,China;School of Public Health,Fujian Medical University,Fuzhou,Fujian 350001,China)
出处
《中国热带医学》
CAS
2020年第3期245-248,258,共5页
China Tropical Medicine
基金
泉州市科技计划项目(No.2019No55S)。
关键词
乙肝
免疫失败
流行特征
Hepatitis B
immunoprophylaxis failure
epidemiological characteristics
