江苏省2010-2015年乙型肝炎母婴阻断效果的随访研究

摘要

目的 观察江苏省乙型肝炎(乙肝)病毒母婴阻断的效果,探讨HBsAg阳性母亲生产的儿童发生慢性HBV感染的相关影响因素.方法 选择2010-2015年江苏省张家港、丹阳、泰兴3个市HBsAg阳性母亲及其分娩的儿童为研究对象,新生儿在出生后24h内接种10μg乙肝疫苗和100 IU乙肝免疫球蛋白(HBIG),于7月龄后采血并用Abbott微粒子化学发光法检测其HBsAg、抗-HBs、抗-HBc的水平.结果 共调查2 099名7～52月龄的儿童,其中34名(1.62％)儿童为慢性HBV感染,logistic回归分析显示母亲HBeAg和分娩年龄是HBV母婴传播的独立危险因素,与HBeAg阴性母亲的儿童相比,HBeAg阳性母亲的儿童发生慢性HBV感染的风险显著增加(RR=4.997,95％CI:2.408～ 10.370);与低年龄组母亲分娩的儿童相比,高年龄组母亲分娩的儿童发生慢性HBV感染的风险显著降低(RR=0.264,95％CI:0.101～0.691).除慢性HBV感染者外,其余2 065名儿童中,9.7％抗-HBs＜ 10 mIU/ml,35.4％抗-HBs为10 ～ 100 mIU/ml,54.9％抗-HBs≥100 mIU/ml,抗-HBs的阳性率为90.3％,抗-HBc的阳性率为13.7％.抗-HBs阳性率和GMT均在7～12个月达到高峰,之后随着年龄增长逐渐下降.结论 江苏省现行乙肝母婴阻断策略实施效果理想,母亲HBeAg阳性是母婴阻断失败的主要危险因素,在有效阻断后仍需进行抗HBs监测,必要时需加强免疫接种.%Objective To evaluate the effects of blocking transmission of HBV from mother to infant in Jiangsu,and discuss influencing factors related to development of chronic HBV infection in children of HBsAg positive mother.Methods HBsAg positive mothers delivered during 2010-2015 in three counties of Jiangsu (Zhangjiagang,Danyang and Taixing) and their neonates were included in the study.The neonates were vaccinated with hepatitis B vaccine (10 μg) and hepatitis B immunoglobin (100 units) within 24 hours after birth.Blood samples were collected from the infants 7 months later,and serum HBsAg,anti-HBs and anti-HBc were detected by Abbott particles chemiluminescence.Results A total of 2 099 children aged 7-52 months were surveyed,of whom 34 (1.62％) developed chronic HBV infection.Logistic regression analysis showed that mother HBeAg positivity (RR=4.997,95％CI:2.408-10.370) was the independent risk factors of mother-to-infant transmission of HBV,while elder delivery age (RR=0.264,95％CI:0.101-0.691) was independent protective factors of HBV transmission.Among the other 2 065 uninfected children,9.7％ had anti-HBs level less than 10 mIU/ml,35.4％ between 10 and 100 mIU/ml,and 54.9％ higher than 100 mIU/ml.The anti-HBs positive rate was 90.3％ and the anti-HBc positive rate was 13.7％.The positive rate and geometric mean titers (GMT) of anti-HBs reached the peaks at 7-12 months after birth,and decreased with the age.Conclusions The current immunological strategy of Jiangsu has good protective efficacy for the interruption of perinatal transmission of HBV.Mother HBeAg positivity is the major risk factor for perinatal blocking failure.Children with effective immunization still need to be monitored for anti-HBs and revaccinated if necessary.