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目的研究乙肝免疫球蛋白(hepatitis B immunoglobulin,HBIG)和10μg重组酵母乙肝疫苗(hepatitis B vaccine,Hep B)联合应用阻断乙肝病毒(hepatitis B virus,HBV)母婴传播效果。方法 2013-2015年以居住在北京市海淀区、乙肝表面抗原(hepatitis B surface antigen,HBsAg)阳性母亲所生、出生时进行过HBV母婴阻断的儿童为研究对象。通过问卷获得被调查儿童的人口学状况、出生医院、HBIG和Hep B接种情况,以及母亲分娩前乙肝e抗原情况。采集儿童静脉血标本5ml,检测HBsAg、乙肝表面抗体(hepatitis B surface antibody,抗-HBs)、乙肝核心抗体(hepatitis B surface antibody,抗-HBc)。计算不同特征儿童的HBsAg和抗-HBs阳性率,并比较其差异。结果共纳入分析儿童377人,HBsAg均为阴性,抗-HBs阳性率为91.25%(344/377)。单因素分析显示,采血距第3剂Hep B(Hep B3)不同间隔儿童抗-HBs阳性率(94.72%VS 70.91%)差异有统计学意义(校正=30.432,P<0.001);多因素logistic回归分析显示,抗-HBs是否阳性与HBIG接种剂量和采血距第3剂Hep B(Hep B3)间隔时间有关,与出生时接种100IU HBIG的儿童(92.56%)相比,接种200IU的儿童抗-HBs阳性率(85.29%)低(OR=0.352,95%CI:0.148~0.834,P=0.018);与采血距Hep B3间隔<3年儿童(94.72%)相比,采血间隔≥3年儿童的抗-HBs阳性率(70.91%)低(OR=0.119,95%CI:0.054~0.262,P<0.001)。结论≥100IU HBIG和10μg重组酵母Hep B联合应用可有效阻断HBV母婴传播;儿童抗-HBs阳性率随时间下降,特别是3年后下降较明显,需对HBsAg阳性母亲所生儿童进行HBV血清学监测,根据结果决定是否需要加强免疫。
Objective To study the effect of hepatitis B immunoglobulin (HBIG) combined with 10 μg of recombinant hepatitis B vaccine (Hep B) on the mother-infant transmission of hepatitis B virus (HBV). Methods From 2013 to 2015, children living in Haidian District, Beijing, with HBsAg positive mothers, who were born at the time of HBV maternal and neonatal blockage were enrolled. The demographic status of the children surveyed, the birth hospital, HBIG and Hep B vaccinations, and the status of pre-delivery hepatitis B e antigen were obtained from the questionnaires. Blood samples of 5 ml were collected from children for detection of HBsAg, hepatitis B surface antibody (anti-HBs) and hepatitis B surface antibody (anti-HBc). The positive rates of HBsAg and anti-HBs in children with different characteristics were calculated and compared. Results A total of 377 children were included in the analysis. HBsAg was negative and anti-HBs positive rate was 91.25% (344/377). Univariate analysis showed that the positive rate of anti-HBs (94.72% VS 70.91%) was statistically significant (corrected = 30.432, P <0.001) in children with different intervals of blood sampling Hep B (Hep B3); multivariate logistic regression Analysis showed that whether anti-HBs was positive was related to the dose of HBIG vaccination and the blood collection interval from Hep B (Hep B3) at age 3, and that 200 IU children were vaccinated against anti-HBs (92.56%) compared with those born at 100 IU HBIG The positive rate (85.29%) was lower (OR = 0.352, 95% CI: 0.148-0.834, P = 0.018). Compared with the blood collection interval of <3 years (94.72% The positive rate of HBs (70.91%) was low (OR = 0.119, 95% CI: 0.054-0.262, P <0.001). Conclusion The combined use of 100IU HBIG and 10μg recombinant yeast Hep B can effectively block the transmission of HBV from mother to infant. The positive rate of anti-HBs in children decreased with time, especially after 3 years. The children with HBsAg-positive mothers should be treated with HBV Serological surveillance, depending on the outcome of the need to strengthen the immune.