乙型肝炎表面抗原和e抗原阳性产妇所生新生儿乙型肝炎母婴传播阻断效果的影响因素

目的探讨乙型肝炎(乙肝)表面抗原(HBsAg)和e抗原(HBeAg)阳性产妇所生新生儿在出生后乙肝疫苗(HepB)和乙肝免疫球蛋白(HBIG)联合免疫以及完成HepB全程免疫后乙肝病毒(HBV)突破性感染的影响因素。方法2016年6月-2017年5月在南昌市2个县(区)选择HBsAg和HBeAg阳性产妇所生新生儿,在联合免疫和HepB全程免疫完成后1-2个月检测血清HBsAg和乙肝表面抗体(HBsAb),分析儿童母婴传播阻断失败率(HBsAg阳性率)。结果本研究共纳入278名婴儿,母婴传播阻断失败率为2.52%(7/278),HBsAb阳性率为96.8%(269/278)。产妇HBsAg阳性时间在2年以上是阻断失败的危险因素,而分娩方式、喂养方式、母亲和婴儿HBIG的使用情况和婴儿性别等与HBV阻断失败率无相关性。结论HepB和HBIG联合免疫对HBsAg和HBeAg阳性产妇所生新生儿具有较好的乙肝母婴传播阻断效果,建议加强育龄妇女HBsAg和HBeAg筛查。

Factors influencing interruption of transmission of hepatitis B virus to infants born to mothers positive for hepatitis B surface antigen and hepatitis B e antigen

Objective To explore factors influencing breakthrough infection of hepatitis B virus(HBV)among infants born to mothers positive for HBV surface antigen(HBsAg)and HBV e antigen(HBeAg)after simultaneous administration of hepatitis B vaccine(HepB)and hepatitis B immunoglobulin(HBIG)to newborn infants followed by administration of 2 more HepB doses during infancy.Methods We enrolled infants born to HBsAg and HBeAg positive mothers from June 2016 to May 2017 in two counties of Nanchang city.We tested blood samples for HBsAg and HBV surface antibody(HBsAb)1 to 2 months after administration of the third dose of HepB to determine the failure rate of interrupting mother-to-child transmission(the HBsAg positivity rate)in infants.Results We enrolled a total of 278 infants;the overall failure rate of interrupting mother-to-child transmission was 2.52%(7/278),and the HBsAb positivity rate was 96.8%(269/278).The sole risk factor for failure to interrupt mother-to-child transmission was maternal HBsAg positivity for over 2 years.Delivery method,feeding method,HBIG use for mothers as well as infants,and gender of the baby were not associated with failure to interrupt HBV transmission.Conclusions Simultaneous administration of HepB and HBIG followed by two more doses of HepB was effective at interrupting mother-to-child transmission of HBV among infants born to HBsAg and HBeAg positive mothers.We should enhance screening of HBsAg and HBeAg among women of childbearing age.