子宫内乙型肝炎病毒感染对新生儿免疫接种的影响

目的　探讨乙型肝炎病毒 (HBV)侵犯新生儿外周血单个核细胞 (PBMC) ,对新生儿免疫接种的影响 ,并从白细胞介素 2 (IL 2 )水平变化分析其可能的机理。方法　对 5 2例乙型肝炎表面抗原 (HBsAg)阳性孕妇分娩的新生儿行乙型肝炎免疫球蛋白和乙型肝炎疫苗 (HBVac)联合免疫接种 ,7个月时进行随访。用巢式聚合酶链反应 (nested PCR)技术检测新生儿血清和PBMC中HBVDNA ,固相放射免疫法检测血清乙型肝炎表面抗体 (HBsAb) ,采用体外细胞培养和双抗体夹心酶联免疫法检测PBMC在植物血凝素 (PHA)和HBsAg刺激下 ,培养上清液中IL 2的含量。结果　HBV侵犯PBMC后 ,新生儿免疫接种的失败率为 73 3% ,显著高于PBMC未受侵犯新生儿的 5 4 % ,差异有显著性 (P<0 0 5 ) ;免疫接种失败新生儿的PBMC培养上清液中 ,IL 2含量为 (85± 37)ng/L(PHA刺激 )、(5 1±18)ng/L(HBsAg刺激 ) ,明显低于免疫接种成功者和正常对照 ,差异均有显著性 (P值均 <0 0 5 )。结论　宫内感染HBV并侵犯PBMC ,是新生儿免疫接种失败的重要原因 ;HBV侵犯PBMC可使其IL 2分泌能力下降 ,可能是导致新生儿免疫接种失败的原因之一

Effect of intrauterine hepatitis B virus infection on hepatitis B vaccine inoculation in newborns

OBJECTIVES: To study the effect and the mechanism of peripheral blood nuclear cells (PBMC) invaded by hepatitis B virus (HBV) on the artificial immunization in newborns. METHODS: Fifty-two newborns, whose mothers were hepatitis B surface antigen (HBsAg) positive, were immunized with hepatitis B immunoglobulin and hepatitis B vaccine (HBVac), and then followed for 7 months. The newborns' serum and PBMC HBV DNA was detected by nested-PCR, hepatitis B surface antibody (HBsAb) was tested with solid phase radioimmunoassay. PBMC from newborn were incubated with PHA and HBsAg. The supernatant interleukin 2 (IL-2) level was measured by enzyme linked immununosorbent assay (ELISA). RESULTS: The rate of vaccination failure was higher in the infants with PBMC HBV DNA positive than those with negative (P < 0.05). The supernatant IL-2 level was lower in the former than that in the latter and the control (P < 0.05). The level of IL-2 in the immunization failure newborns was lower than that in the vaccination success and the control (P < 0.05). CONCLUSIONS: The intrauterine PBMC HBV invasion is one of the important causes of vaccination failure in the newborns. PBMC IL-2 autocrine down regulation is closely related to HBV invasion, that may lead to the failure of HBVac inoculation in the newborns.