乙型肝炎病毒e抗原阳性孕妇所生婴儿联合免疫接种后乙型肝炎病毒血清学标志物的动态变化

目的 观察HBeAg阳性且HBV DNA高载量孕妇所生婴儿用乙型肝炎疫苗联合免疫接种后的母婴阻断效果及HBV血清学标志物的动态变化.方法 回顾性分析HBeAg阳性且HBVDNA≥106拷贝/ml孕妇127例,婴儿出生后即刻及第15天于臀大肌注射高效价乙型肝炎免疫球蛋白200 IU,出生时与第1、6个月于右上臂肌肉注射乙型肝炎疫苗20μg,随访其婴儿至12个月龄.用酶联免疫吸附法及荧光定量PcR检测婴儿出生时及第1、7、12个月时的HBV血清学标志物和HBV DNA载量,观察婴儿出生时HBV血清学标志物模式、母婴传播率、疫苗接种后的HBV宫内感染率、抗-HBs阳性保护率及HBV血清学标志物动态变化.结果 127例孕妇分娩婴儿均为单胎,出生时29例婴儿HBsAg为阳性,其中11例合并HBV DNA阳性,母婴垂直传播率为22.83％.随访至1个月,10例婴儿合并HBV DNA阳性从而发生HBV宫内感染,表现为HBsAg、HBeAg及抗-HBc均为阳性.2例婴儿HBsAg弱阳性,伴有抗-HBs滴度的产生,后续随访中均转阴,乙型肝炎宫内感染率为7.87％.非宫内感染婴儿出生时HBeAg及抗-HBc阳性率分别为96.58％和98.29％,免疫接种后婴儿HBeAg及抗-HBc逐步转阴,均未产生抗-Hbe.非宫内感染婴儿均产生有效乙型肝炎保护性抗体,乙型肝炎疫苗及高效价乙型肝炎免疫球蛋白联合免疫接种后,婴儿抗-HBs滴度从出生至12个月龄逐步上升,母源性HBeAg滴度逐步下降以至转阴.结论 乙型肝炎疫苗联合高效价乙型肝炎免疫球蛋白免疫接种能明显降低HBV母婴传播,增强婴儿乙型肝炎表面抗原保护性抗体,体内母源性HBeAg及抗-HBc亦随之降低甚至转阴.

Abstract efficacy of combined vaccine for the prevention of HBV transmission in highly viremic HBeAg+ mothers and the HBV markers' dynamic change of babies in follow-up

Objective To evaluate the efficacy of combined vaccination with 200IU dose of HBIG and 20 μg of anti-HBV vaccine for the prevention of HBV vertical transmission in babies dilivered by HBeAg + and highly viremic mothers and the HBV markers' dynamic changes in babies during followup.Methods HBeAg + mothers with HBV DNA≥1.0×6log10 copies/ml were enrolled and their babies were followed up until 12 months old.The infants received HBIG 200 IU IM in 24 hrs and on day 15,and 20 μg recombinant anti-HBV vaccine at 0,land 6months.The HBV markers and HBV DNA were tested at birth day,and 1,7,12 months after birth respectively.The vertical transmission rate at birth and intrauterine infection rate,the HBsAb positive rate and the HBV markers' dynamic changes during follow up were evaluated.Results (1) 29 out of 127 infants with HBsAg (+) at birth,11 of which were HBV DNA (+),HBV perinatal transmission rate was 22.83％.2 infants' HBsAg were positive at monthl and became negative at month 7 and 10 infants were still HBsAg (+) and HBV DNA (+).HBV intrauterine infection rate was 7.87％.(2) The positive rate of HBeAg and HBcAb in uninfected infants were 96.58％ and 98.29％ respectively,which declined gradually to undetectable level after immunization.No infants were HBeAb (+).(3) Infants uninfected produced effective HBsAb after vaccination.The level of HBsAb elevated gradually,and the level of HBeAg decreased quickly even to undetectable.Conclusion The combination vaccination of 200 IU HBIG with 20 μg recombinant anti-HBV vaccine in the Infants delivered by HBeAg + and highly viremic mothers reduced obviously the rate of perinatal transmission of HBV,enhanced largely the production of antibody against HBV surface antigen and dropped the maternal HBeAg and HBcAb in infants or even to negative.