新生儿静脉血HBsAg含量预测HBV母婴传播阻断效果的研究

摘要

Objective To investigate the role of HBsAg status and content in neonatal venous blood to predict HBV mother-to-children transmission.Methods The study candidates from a prospective study about HBV mother-to-children transmission blocking who were hepatitis B surface antigen (HBsAg) positivity,hepatitis B e antigen (HBeAg) positivity,and HBV DNA levels ＞105 IU/ml.All of their infants were enrolled.200 IU of hepatitis B immunoglobulin (HBIG)was injected within 6 hours after birth,and 200 IU HBIG was voluntarily selected 1 month after birth.All infants according to 0-1-6 month standard procedure were given 10 or 20 μg of hepatitis B vaccine.Pregnancy women before birth,and infants at the time of birth,l-month and 7-month after birth,venous blood was tested for HBV virus and serological markers to assess the association with success of mother-to-children transmission blocking.Results 530 pregnant women and 530 neonates were enrolled.60.75％ at birth and 86.02％ at birth for one month children were HBsAg-negative.The successful transmission in HBsAg-negative neonates was 100.00％.According to the receiver operating characteristic curve,the AUC of HBsAg content≥ 0.35 IU/ml at birth predicted to block failure was 0.979.The sensitivity was 85.60％,and the specificity was 100.00％.The AUC of HBsAg content≥0.18 IU/ ml at one month after birth predicted to block failure was 0.988,the sensitivity was 89.40％,and the specificity was 100.00％.Conclusions The HBsAg level in venous blood at birth and 1 month after birth can predict the failure of HBV mother-to-children transmission,and the neonates with HBsAg positivity in venous blood are a high-risk group that may block failure.%目的 探讨新生儿静脉血HBsAg状态及其含量预测HBV母婴传播阻断的作用.方法 从HBV母婴传播阻断效果前瞻性研究队列患者中入组HBsAg、HBeAg双阳性和HBV DNA含量＞105IU/ml孕妇及其新生儿.新生儿出生后6h内注射200 IU乙肝免疫球蛋白(hepatitis B immunoglobulin,HBIG),出生后1个月自愿选择注射200 IU乙肝免疫球蛋白,并按第0、1和6个月标准程序接种乙肝疫苗10～20 μg.孕妇于分娩前、新生儿出生时、出生后1个月和7个月检测静脉血HBV病毒和血清学指标,评估其与HBV母婴阻断成功的相关性.结果 共入组孕妇及其所生新生儿530例.出生时60.75％和出生1个月86.02％为HBsAg阴性,HBsAg阴性新生儿的HBV母婴传播阻断成功率为100.00％,经受试者工作特征曲线分析,出生时HBsAg≥ 0.35 IU/ml预测阻断失败的AUC为0.979,灵敏度为85.60％,特异度为100.00％;出生后1个月HBsAg ≥0.18 IU/ ml预测阻断失败的AUC为0.988,灵敏度为89.40％,特异度为100.00％.结论 出生时和出生后1个月新生儿静脉血HBsAg水平可预测HBV母婴传播阻断失败,静脉血HBsAg阳性的新生儿是阻断失败的高危人群.