【摘要】 为了解宫内受乙型肝炎（简称乙肝）病毒（ＨＢＶ）感染婴儿接种乙肝疫苗导致免疫失败的机理和预后，用植物血凝素（ＰＨＡ）作淋巴细胞增殖试验，用ＨＢＶ前Ｓ２多肽特异性扩增ＨＢＶＤＮＡＳ区基因并分析其变异情况。对４９７名携带ＨＢＶ母亲所生新生儿单纯接种乙肝疫苗，并对携带ＨＢＶ母亲产前注射免疫球蛋白（ＨＢＩＧ）（妇产组）；对携带ＨＢＶ产前不注射ＨＢＩＧ母亲所生４９０名新生儿生后注射ＨＢＩＧ加乙肝疫苗（中山组）。两组均随访４～６年。结果显示，妇产组ＨＢＶ的宫内感染率为１４．３％，中山组ＨＢＶ的宫内感染率为５．７％；淋巴细胞增殖试验显示宫内感染ＨＢＶ后其细胞免疫功能不足，Ｔ淋巴细胞对ＨＢＶ的特异性刺激源处于免疫耐受状态。孕妇产前多次注射ＨＢＩＧ能有效减少ＨＢＶ的宫内感染；在受宫内ＨＢＶ感染的儿童中存在着乙肝病毒变异，感染变异病毒是接种乙肝疫苗免疫失败的重要原因，并易发展为慢性乙型肝炎更多还原

【Abstract】 In utero hepatitis B virus (HBV) infection is the major cause of failure of vaccination against hepatitis B in neonate born to HBV carrier mother. To understand the mechanism and the prognosis of immune failure after administration of Hepatitis B (HB) vaccine to intrauterine HBV infected infants we observed the response to the vaccine, analysed T lymphocyte subgroups, lymphocyte proliferation after stimulation with PHA and HBV pre S2 peptide, and performed tests for genomic mutation of HBV DNA S region. 497 neonates born to HBV carrier mothers received HB vaccine alone, 490 neonates, whose mothers were injected with HBIG before delivery, received HBIG and HBV vaccine. All infants were be followed up for 4～6 years. The results showed that the prevelance of intrauterine HBV infection was 14.3%. The high risk factors of HBV intrauterine infection were HBsAg and HBeAg double positivity and HBV DNA positivity in peripheral blood of pregnant women. HBV infection in utero could be interrupted by using multipe HBIG injections to pregnant women before delivery. Inoculation with HB vaccine or HBIG plus HB vaccine at birth was effective for children of intrauterine HBV infection; anti HBs antibody was positive in 56.3% and 63.4%, respectively. The lymphocyte proliferation tests showed that in intrauterine HBV infected infants there was insuficient cellmediated immunity and that T lymphocyte was tolerant to HBV. There was HBV mutation in intrauterine HBV infected children. The HBV variance was also an important cause of immune failure after adminis tration of HB vaccine and development of chronic hepatitis B.更多还原