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目的探讨可能导致HBsAg阳性产妇分娩的婴儿乙肝免疫接种后免疫低和无应答的因素。方法回顾性分析2013-2014年在首都医科大学附属北京佑安医院收治的HBsAg阳性产妇分娩的832例新生儿的临床资料,新生儿出生后6 h内及21 d接种乙型肝炎免疫球蛋白200 IU,出生当天和出生后1、6个月注射乙型肝炎疫苗10μg。出生后6 h内、7月龄抽取股静脉血,检查HBV标志物和HBV DNA定量。按照产妇孕期是否接受抗病毒治疗、母乳喂养、父亲HBsAg情况、母亲HBeAg情况分组,评估上述因素对婴儿乙肝免疫接种应答情况的影响。结果产妇孕期接受抗病毒治疗组的婴儿低和无应答率为8.6%(25/290),未行抗病毒治疗组的婴儿低和无应答率为7.0%(38/542),差异无统计学意义(χ~2=0.60,P=0.44)。母乳喂养组婴儿的低和无应答率为8.8%(18/204),人工喂养组低和无应答率为7.2%(45/628),差异无统计学意义(χ~2=0.52,P=0.47)。父亲HBsA g阳性组的婴儿低和无应答率为20.0%(5/25),父亲HBsAg阴性组的婴儿低和无应答率为7.2%(58/807),差异无统计学意义(χ~2=3.00,P=0.08)。母亲HBeAg阳性组的婴儿低和无应答率为9.9%(33/335),母亲HBeAg阴性的婴儿低和无应答率为6.0%(30/497),差异无统计学意义(χ~2=3.55,P=0.06)。结论 HBsAg阳性产妇分娩的婴儿中,母亲孕期采用抗病毒治疗、母乳喂养、父亲HBsAg阳性和母亲HBeAg阳性对婴儿乙肝免疫应答无明显影响。
OBJECTIVE: To investigate the immunosuppressive and nonresponsive factors of hepatitis B immunization in infants who may give birth to HBsAg-positive mothers. Methods The clinical data of 832 newborns with HBsAg positive mothers delivered at Beijing You’an Hospital Affiliated to Capital Medical University from 2013 to 2014 were retrospectively analyzed. The newborns were vaccinated with hepatitis B immunoglobulin 200 IU, on the day of birth and 1,6 months after birth, hepatitis B vaccine injection 10μg. Within 6 h after birth, femoral vein blood was drawn at 7 months of age and HBV markers and HBV DNA were quantified. The impact of these factors on the response to hepatitis B immunization in infants was assessed according to whether the mothers received antiretroviral therapy during pregnancy, breastfeeding, father’s HBsAg status, and mother’s HBeAg status. Results The low and non-response rate of infants who received antiretroviral therapy during pregnancy was 8.6% (25/290), that of infants who did not receive antiretroviral therapy was 7.0% (38/542), the difference was not statistically significant Significance (χ ~ 2 = 0.60, P = 0.44). The breast-feeding infants had a low and no response rate of 8.8% (18/204), low and non-responder rate of 7.2% (45/628) in the fed group, with no significant difference (χ ~ 2 = 0.52, P = 0.47). The low and no response rate of infants with HBsAg positive group was 20.0% (5/25), while that of fathers with HBsAg negative group was 7.2% (58/807), with no significant difference (χ ~ 2 = 3.00, P = 0.08). Infants with HBeAg-positive mothers had a low and non-responsive rate of 9.9% (33/335), maternal HBeAg-negative infants with low and no response rates of 6.0% (30/497), with no significant difference (χ ~ 2 = 3.55 , P = 0.06). Conclusion In infants born to HBsAg positive mothers, the mothers’ anti-HBV treatment during pregnancy, breastfeeding, HBsAg positive mothers and HBeAg positive mothers had no significant effect on the immune response to hepatitis B in infants.