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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。
Objective To explore the effect of immunoprophylaxis in high-risk children with hepatitis B and the influencing factors of mother-to-infant transmission in order to provide a reference for reducing the rate of hepatitis B infection in children. Methods The clinical data of 431 HBsAg positive pregnant women and 452 high-risk hepatitis B patients aged 1-5 years admitted to Hunan MCH from August 2012 to January 2016 were retrospectively analyzed. Through the detection of hepatitis B The influential factors and immunoprophylaxis effects of HBV mother-to-child transmission were analyzed. Results All the 452 high-risk hepatitis B patients were vaccinated with hepatitis B vaccine (0-1-6), and 94.91% (429/452) high risk infants were injected with hepatitis B immunoglobulin (HBIG). Totally 19 children were tested positive for HBsAg Rate was 4.20%. The infection rate of high-risk children with combined immunization was 1.40% (6/429), the rate of pure immune hepatitis B was 56.52% (13/23), the difference was statistically significant (P = 0.000) There was no significant difference in the infection rate of high-risk children (P = 0.971), but with the increase of age, the positive rate of HBs Ab gradually decreased (P = 0.000). Univariate analysis of the influencing factors of HBV mother- , HBVDNA copy number≥106 and both could lead to high risk infants infection rate (P = 0.000) .Multivariate logistic regression analysis of the above two groups of influencing factors showed that the mother HBeAg positive HBV-DNA copy number≥106 Independent risk factors for infant transmission. Conclusion The HBeAg positive and HBV-DNA copy number≥106 are independent risk factors for mother-to-child transmission. Prenatal intervention should be strengthened to reduce the incidence of hepatitis B infection. HBsAb monitoring should be strengthened during the growth and development of high-risk infants to maintain the level of hepatitis B Antibody level.