西安市HBsAg阳性产妇HBV宫内传播的流行病学研究

胡妮; 续靖宁; 李芳; 付婷; 王海荣; 高洁; 张磊

文章摘要

胡妮,续靖宁,李芳,付婷,王海荣,高洁,张磊.西安市HBsAg阳性产妇HBV宫内传播的流行病学研究[J].中华流行病学杂志,2019,40(9):1059-1064

西安市HBsAg阳性产妇HBV宫内传播的流行病学研究

Epidemiology study of intrauterine transmission of HBV in HBsAg-positive parturients in Xi’an

收稿日期:2019-02-01 出版日期:2019-09-16

DOI：10.3760/cma.j.issn.0254-6450.2019.09.008

中文关键词: 乙型肝炎病毒宫内传播显性感染隐匿性感染

英文关键词: HBV Intrauterine transmission Dominate infection Occult infection

基金项目:国家自然科学基金（81102140，81472988，81373058）；陕西省重点研发计划（2018SF-166）

作者	单位	E-mail
胡妮	空军军医大学军事预防医学系流行病学教研室特殊作业环境危害评估与防治教育部重点实验室, 西安 710032 西安市疾病预防控制中心 710054
续靖宁	西北妇女儿童医院, 西安 710061
李芳	西北妇女儿童医院, 西安 710061
付婷	空军军医大学军事预防医学系流行病学教研室特殊作业环境危害评估与防治教育部重点实验室, 西安 710032
王海荣	空军军医大学军事预防医学系流行病学教研室特殊作业环境危害评估与防治教育部重点实验室, 西安 710032
高洁	空军军医大学军事预防医学系流行病学教研室特殊作业环境危害评估与防治教育部重点实验室, 西安 710032
张磊	空军军医大学军事预防医学系流行病学教研室特殊作业环境危害评估与防治教育部重点实验室, 西安 710032	drzhanglei@fmmu.edu.cn

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中文摘要:

目的了解西安市HBsAg阳性孕妇发生HBV宫内传播（BIT）现况及其影响因素，随访幼儿HBV传播转归和对乙型肝炎（乙肝）疫苗免疫应答情况。方法 2015年1月至2018年1月在陕西省西北妇女儿童医院对341例HBsAg阳性产妇进行流行病学调查，并对其所生344例新生儿于产后24 h内以及1岁后静脉血进行血清学检测。采用巢式病例对照研究设计，分组分析新生儿发生BIT、宫内显性感染（DBI）和宫内隐匿性感染（OBI）情况及其发生的影响因素，在2016年8月至2018年10月对该幼儿人群进行随访，获得高危幼儿HBV传播的转归和HBsAb阳性率。结果 HBsAg阳性产妇所生新生儿发生BIT、DBI和OBI率为46.51%（160/344）、8.14%（28/344）和38.37%（132/344），HBeAg阳性产妇所生新生儿发生DBI和BIT的风险分别是HBeAg阴性产妇的2.60倍（95% CI：1.19～5.70）和2.21倍（95% CI：1.36～3.61）；产妇外周血HBV DNA载量≥200、≥10³和>10⁶拷贝/ml者所生新生儿发生BIT的风险分别是<200、<10³和≤10⁶拷贝/ml者的1.99倍（95% CI：1.29～3.08）、1.73倍（95% CI：1.11～2.69）及2.33倍（95% CI：1.33～4.10）；发生前置胎盘产妇所生新生儿发生DBI是无前置胎盘者的14.07倍（95% CI：1.23～160.76）；孕期未注射乙肝免疫球蛋白者所生新生儿发生BIT是注射者的1.60倍（95% CI：1.02～2.53）。随访发现，14例DBI幼儿，9例发生HBsAg转阴（9/14）；OBI率为24.17%（22/91）；乙肝疫苗免疫总的应答率为69.23%（63/91）。OBI幼儿的乙肝疫苗免疫应答率为59.09%（13/22）。结论 HBsAg阳性产妇所生幼儿随访中发现，OBI较高，乙肝疫苗应答率较低，是乙肝防控的空白区域，应加强育龄妇女及幼儿HBV监测、HBsAg阳性产妇控制乙肝干预是控制传染源和保护易感人群的重要措施。

英文摘要:

Objective To investigate the current status and influence factors of HBV intrauterine transmission (BIT) in HBsAg-positive parturients and understand the outcome of HBV transmission and response to hepatitis B vaccine immunization in children in Xi'an. Methods An epidemiological survey was conducted in 341 HBsAg-positive parturients who gave birth in Northwest Women and Children Hospital of Shaanxi Province from January 2015 to January 2018. Serological tests were performed by using venous blood from 344 newborns within 24 hours after birth and at the age of 1 year old. A nested case-control study was conducted to analyze the infection rates of intrauterine dominate HBV infection (DBI) and intrauterine occult HBV infection (OBI) in BIT and their influencing factors in newborns. The epidemiological survey was conducted to collect the information about the outcome of HBV transmission and the positive rate of HBsAb in children at high-risk from August 2016 to October 2018. Results The BIT rate was 46.51%(160/344) in HBsAg-positive parturients, the DBI rate was 8.14% (28/344), the OBI rate was 38.37% (132/344), and the odds ratio of DBI and BIT in neonates of HBeAg-positive parturients were respectively 2.60 (95%CI:1.19-5.70) and 2.21 (95%CI:1.36-3.61) times higher than that of HBeAg-negative parturients. The odds ratio of BIT in neonates with maternal peripheral blood HBV DNA load ≥ 200, ≥ 10³ and >10⁶ copies/ml were 1.99 (95%CI:1.29-3.08), 1.73 (95%CI:1.11-2.69) and 2.33 (95%CI:1.33-4.10) times higher than those in neonates with maternal peripheral blood HBV DNA <200, <10³, and ≤ 10⁶ copies/ml respectively. The incidence of DBI in neonates of parturients with placenta previa was 14.07 times higher than that of parturients without placenta previa (95%CI:1.23-160.76). The incidence of BIT in neonates of parturients who received no hepatitis B immunoglobulin during pregnancy was 1.60 times higher than that in neonates of those who received hepatitis B immunoglobulin (95%CI:1.02-2.53). Follow-up results showed that HBsAg negative conversion was found in 9 of 14 children with DBI, and 24.17%(22/91) of children had OBI. The overall rate of immune response to hepatitis B vaccine was 69.23%(63/91). The immune response rate in children with OBI was only 59.09%(13/22). Conclusion Newborns of HBsAg-positive parturients had high rate of OBI and lower rate of immune response to hepatitis B vaccine detected in follow-up, indicating a gap in hepatitis B prevention and control. HBV monitoring and intervention in HBsAg-positive women of childbearing age and hepatitis B antibody monitoring in children at high-risk are important measures to control infection source and protect susceptible population.

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