云南HBsAg阳性孕产妇生产婴儿免疫应答及感染状况分析

康文玉; 王锋; 李琼芬; 张丽芬; 许琳; 田子颖; 沈立萍

doi:10.11847/zgggws2017-33-12-16

云南HBsAg阳性孕产妇生产婴儿免疫应答及感染状况分析

Hepatitis B virus infection and immune response among infants born to HBV surface antigen positive mothers in Yunnan province

摘要

摘要: 目的了解云南省乙肝表面抗原（HBsAg）阳性孕产妇所生婴儿在实施母婴阻断后的免疫应答及乙肝感染状况。方法筛查出全云南省2011年1-6月入院分娩的HBsAg阳性孕产妇，实施母婴阻断后以其所生婴儿为调查对象，于7-12月龄采集静脉血2 mL，分离出血清标本先统一采用ELISA法做乙肝血清学5项指标检测，筛选出HBsAg阳性的标本采用荧光定量PCR法进行乙肝病毒载量（HBV DNA）检测，筛选出HBsAg阴性且乙肝表面抗体（anti-HBs，抗-HBs）阳性的标本采用化学发光法做抗-HBs定量检测。结果共收集到调查对象3 026人，母婴阻断实施后免疫应答率为92.43%，有效免疫应答率为80.04%；低、无免疫应答者占16.09%；母婴阻断失败率为3.87%。本次调查共检出10种乙肝血清标志物组合模式，检出率最高为模式6，占74.62%：其次为模式5，占14.44%：再次为模式7，占3.70%：模式4占3.37%。母婴阻断失败组中，HBV DAN含量>5×10⁷ IU/mL占45.30%；500~5×10⁷ IU/mL占39.32%；<500 IU/mL占15.38%；HBeAg阳性率为79.49%。产生免疫应答组检出3种血清组合模式，乙肝病毒e抗体（anti-HBe，抗-HBe）阳性率为3.79%，乙肝病毒核心抗体（anti-HBc，抗-HBc）阳性率为23.20%。定量检测抗-HBs，抗体水平>1 000 mIU/mL的高免疫应答者占66.93%，抗体水平在100~1 000 mIU/mL的中免疫应答者占19.66%，抗体水平在10~100 mIU/mL的低免疫应答者占13.41%。经统计分析，产生免疫应答抗-HBs的抗体水平高低与婴儿体内是否携带抗-HBe、抗-HBc及性别无关。结论对HBsAg阳性孕产妇所生婴儿实施母婴阻断，并建立健全产后对婴儿追踪机制，对预防和控制婴儿感染乙肝起关键作用。

Abstract: Objective To examine the infection prevalence of and immune response to hepatitis B virus (HBV) among infants born to HBV surface antigen (HBsAg) positive mothers in Yunnan province.Methods The HBsAg positive women were screened out from all pregnant women hospitalized for their delivery in Yunnan province between January through June 2011; then procedures for the prevention of mother-to-infant transmission (PMTCT) were implemented among the participants and their newborns.The venous blood specimens (2 milliliters for each) were collected from the participants' infants aged 7-12 months and detected for HBsAg,antibody to HB surface antigen (anti-HBs),hepatitis B e antigen (HBeAg),antibody to HB e antigen (anti-HBe),and antibody to HB core antigen (anti-HBc) with enzyme-linked immunosorbent assay (ELISA).The specimens positive to HBsAg were further quantified for HBV-DNA with PCR-fluorescent probing and those negative to HBsAg but positive to anti-HBs were detected for the quantification of anti-HBs with chemiluminescence immunoassay.Results Among a total of 3 026 infants with PMTCT,the immune response rate was 92.43% and the effective immune response rate was 80.04%,while the proportion of the infants presenting non-effective immunity was 16.09% and the failure rate of PMTCT was 3.87%.For all specimens detected,74.62% were anti-HBs positive-only; 14.44% were both anti-HBs and anti-HBc positive; 3.70% were negative for all the five indicators; and 3.37% were anti-HBs,anti-HBe and anti-HBc positive.For all the infants identified as PMTCT failure,45.30%,39.32%,and 15.38% were determined with the HBV-DNA of >5×10⁷ IU/ml,500-5×10⁷ IU/ml,and <500 IU/ml and 79.49% were HBeAg positive.Among the infants with effective immune response,80.73% were anti-HBs positive-only; 16.62% were both anti-HBs and anti-HBc positive; 3.65% were anti-HBs,anti-HBc and anti-HBe positive; and the positive rate of anti-HBc and anti-HBe were 23.20% and 3.79%,respectively.Of all the infants with effective immune response,66.93%,19.66%,and 13.41% were detected with the anti-HBs level of >1 000 mIU/ml,100-1 000 mIU/ml,and 10-99 mIU/ml.The results of statistical analyses demonstrated that immune response level was irrelevant neither to gender nor to serum positivity of anti-HBe and anti-HBc.Conclusion The implementation of PMTCT and postpartum medical follow-up play a critical role for the prevention and control of HBV infection among the infants born to HBsAg positive mothers.

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