【摘要】 目的探讨乙肝高危儿免疫预防的效果及母婴传播的影响因素,为降低儿童乙肝感染率提供参考依据。方法回顾性分析湖南省妇幼保健院于2012年8月-2016年1月收治的431例HBsAg阳性产妇及其1~5岁的452例乙肝高危儿的临床资料,通过检测乙肝高危儿的乙肝标志物,分析HBV母婴传播的影响因素及免疫预防效果。结果 452例乙肝高危儿全部规范接种了乙肝疫苗(0-1-6),94.91%(429/452)高危儿联合注射了乙肝免疫球蛋白(HBIG);经检测,19例儿童HBsAg阳性,感染率4.20%;联合免疫乙肝高危儿感染率为1.40%(6/429),单纯免疫乙肝感染率为56.52%(13/23),比较差异有统计学意义(P=0.000);不同年龄段乙肝高危儿感染率差异无统计学意义(P=0.971),但随着年龄增加,HBs Ab阳性率逐渐下降(P=0.000);对HBV母婴传播影响因素进行单因素分析结果显示,母亲HBeAg阳性、HBVDNA拷贝量≥106与均会导致高危儿感染率升高(P=0.000);对上述两组影响因素进行多因素logistic回归分析显示,母亲HBeAg阳性、HBV-DNA拷贝量≥106是导致母婴传播的独立危险因素。结论母体HBeAg阳性、HBV-DNA拷贝量≥106是导致母婴传播的独立危险因素,孕期应加强预防干预,降低婴儿乙肝感染率;在高危儿生长发育过程中要加强HBs Ab监测,维持机体乙肝抗体水平。更多还原

【Abstract】 Objective To explore the efficacy of hepatitis B immunoprophylaxis and the factors influencing mother-to-child transmission of hepatitis B virus in children at high risk of hepatitis B so as to provide a basis for declining the infection rate of hepatitis B in children.Methods We retrospectively analyzed the clinical data regarding 431 HBsAg-positive mothers and their452 children aged 1-5 years at high risk of hepatitis B hospitalized in Hunan Provincial Maternal and Child Health Hospital from August 2012 to January 2016.Hepatitis B markers in the children were detected,and the factors influencing mother-to-child transmission of hepatitis B virus and the efficacy of hepatitis B immunoprophylaxis were analyzed.Results The 452 children at high risk of hepatitis B all received a full course of HBV vaccination,and 94.91% (429/452) were injected with hepatitis B immunoglobulin (HBIG).The infection rate of HBsAg was 4.20% (19/452) for total,and significantly lower in children with combined immunization (1.40%,6/429) than in those with single immunization (56.52%,13/23) (P = 0.000).It was not significantly different among different age groups (P = 0.971).HBs Ab positive rate decreased gradually with the increase of age (P =0.000).Univariate analysis showed that HBeAg-positive mothers and HBV-DNA copy ≥ 106 could result in higher infection rate in the high risk children (P = 0.000).Multivariate logistic regression analysis showed that HBeAg-positive mothers and HBV-DNA copy ≥ 106 were the independent risk factors of mother-to-child transmission of hepatitis B virus.Conclusions HBeAg-positive mothers and HBV-DNA copy ≥ 106 are the independent risk factors for mother-to-child transmission of hepatitis B virus.It is necessary to strengthen prevention and intervention during pregnancy so as to decline the infection rate of hepatitis B in infants.More attention should be paid to intensify HBs Ab monitoring during the growth and development of children at high risk of hepatitis B and maintain the antibody level against hepatitis B virus.更多还原