HBsAg阳性孕产妇其幼儿乙型肝炎疫苗免疫应答情况及其影响因素

  目的  获取HBsAg阳性孕产妇其幼儿乙型肝炎(乙肝)疫苗无/弱应答的概率，分析其影响因素。  方法  对2016年1月至2017年4月在陕西省西北妇女儿童医院分娩的284对HBsAg阳性孕产妇及其幼儿进行研究，随访幼儿乙肝疫苗接种情况及血清学标志物产生情况。  结果  高危幼儿无/弱应答率为10.57%(28/237)。表面抗原(HBsAg)、e抗原(HBeAg)和核心抗体(HBcAb)均阳性的孕产妇其幼儿发生乙肝疫苗免疫无/弱应答率为19.64%，高于HBsAg、e抗体(HBeAb)和HBcAb均阳性的孕产妇的幼儿，其乙肝免疫无/弱应答率为9.89%(RR=1.99，95% CI:1.01~3.92，P＜0.001)。孕期有穿刺史者其幼儿发生无/弱应答的风险是无穿刺史者的6.72倍(RR=6.72，95% CI:2.79~16.19，P=0.049)，幼儿发生乙肝疫苗无/弱应答的孕产妇白蛋白(ALB)低于强应答组(t=2.518，P=0.013)，白球比(A/G)高于强应答组(t=-5.559，P＜0.001)。  结论  HBsAg阳性孕产妇幼儿是乙肝疫苗无/弱应答的重点人群，其又处于母亲为传染源的高危环境中，应重点进行抗体监测。其孕期有创检查可能会增加幼儿发生乙肝疫苗无/弱应答的概率。HBsAg、HBeAg和HBcAb均表现为阳性的孕产妇幼儿有较高的乙肝疫苗免疫无/弱应答率。

The immune response to hepatitis B vaccine and its influencing factors of infants born to HBsAg positive mothers

  Objective  To obtain the probability of no/weak immune response to the hepatitis B vaccine of infants born to HBsAg-positive parturients, so as to analyze its influencing factors.  Methods  A study of 284 pairs of HBsAg-positive pregnant women and their infants who gave birth at the Northwest Women and Childre's Hospital of Shaanxi Province from January 2016 to April 2017 was carried out to follow up of infant hepatitis B vaccination and the production of serological markers.  Results  The rate of immune deficiency and weak response in high-risk children was 10.57%. The rate of immune deficiency and weak response in pregnant women with "HBsAg+, HBeAg+, HBcAb+" infection pattern was 19.64%, which was significantly higher than that of pregnant women in "HBsAg+, HBeAb+, HBcAb+" mode, which was 9.89% (RR=1.99, 95% CI: 1.01-3.92, P < 0.001). The risk of HBsAg-positive mothers with puncture history during pregnancy was 6.72 times higher than that of children with no puncture history (RR=6.72, 95% CI: 2.79-16.19, P=0.049). The liver function albumin (ALB) of the mothers who had immune deficiency and weak response to hepatitis B vaccine in young children was significantly lower than that in the strong response group (t=2.518, P=0.013). The liver function-to-white ratio (A/G) of the mothers who had immune deficiency and weak response to hepatitis B vaccine was significantly higher than that of the strong response group (t=-5.559, P < 0.001).  Conclusions  Children born to HBsAg positive mothers are at high risk of immune deficiency and weak response to Hepatitis B vaccine and intrauterine transmission of hepatitis B. Therefore, we should focus on monitoring the HBsAb production of these people. Invasive testing during pregnancy may increase the risk of immune deficiency and weak response to Hepatitis B vaccine in young children. Children have a higher hepatitis B vaccine deficiency and weak response rate when their mother's serological testing remains "HBsAg+, HBeAb+, HBcAb+" mode.