临床肝胆病杂志2018，Vol.34Issue(6)：1198-1203,6.DOI:10.3969/j.issn.1001-5256.2018.06.014
新生儿乙型肝炎疫苗免疫低应答的影响因素分析
Influencing factors for low response to hepatitis B vaccination in neonates
摘要
Abstract
Objective To investigate the influencing factors for low response to hepatitis B (HepB) vaccination in neonates born to HBsAg-positive mothers.Methods A total of 1152 neonates born to HBsAg -positive mothers who participated in the project of prevention of mother -to -child transmission of HBV from July 2012 to July 2015 were enrolled.After 96 neonates were excluded,1056 neonates were included in the final analysis, including 714 neonates born to HBsAg -positive/HBeAg -negative mothers and 342 neonates born to HBsAg -positive/HBeAg -positive mothers.These two groups of neonates were given immunization at different doses , i.e., 10 μg or 20 μg HepB derived in Saccharomyces cerevisiae and 100 IU hepatitis B immunoglobulin within 2 hours after birth, followed by the injection of 10 μg or 20 μg HepB at the ages of 1 and 6 months.Venous blood samples were collected at one month after the last immunization to measure the lev -els of HBsAg and anti -HBs.The neonates with anti -HBs <100 mIU/ml were classified as low responders, and those with anti -HBs ≥100 mIU/ml were classified as high responders.The two -independent -samples t test was used for comparison of continuous data between groups, and the chi -square test or the Fisher′s exact test was used for comparison of categorical data between groups .An unconditional logistic regression analysis was used to identify the influencing factors for low response to HepB in neonates .An analysis of covariance was used for comparison of the level of anti -HBs between groups.Results Compared with the 20 μg group, the 10 μg group had a significantly higher rate of low response (5.7% vs 2.0%, χ2 =7.278, P =0.007), significantly lower maternal HBV DNA load [(2.90 ±1.50)log10 IU/ml vs (7.73 ±1.07)log10 IU/ml, t =-50.297, P <0.001)] and proportion of the mothers who received antiviral therapy during preg -nancy (0.7% vs 7.0%, χ2 =34.552, P <0.001), and a significantly higher rate of preterm birth (3.2% vs 1.2%, χ2 =3.907, P =0.048).The 10 μg group had a significantly lower proportion of neonates with artificial feeding than the 20 μg group (37.8% vs 66.4%,χ2 =75.703, P <0.001).In the 10 μg group, the unconditional logistic regression analysis showed that preterm birth (odds ratio [OR] =3.31, 95% confidence interval [CI]: 1.05 -10.40, P <0.05) and artificial feeding (OR =2.67, 95%CI: 1.38 -5.07, P <0.05) were independent risk factors for low response to HepB vaccination .The analysis of covariance showed that compared with the full -term infants,the preterm infants had a significantly lower level of anti -HBs (P =0.004); compared with those given breastfeeding or mixed feed -ing, the neonates given artificial feeding had a significantly lower level of anti -HBs (P =0.001).In the 20 μg group, no maternal factors or infantile factors were found to be associated with the response to HepB vaccination (all P >0.05).Conclusion Preterm birth and artificial feeding are risk factors for low response to HepB vaccination in neonates .Identification of neonates at risk of low response to HepB vacci -nation will provide a basis for developing individualized HepB vaccination schemes .关键词
肝炎疫苗,乙型/婴儿,新生Key words
hepatitis B vaccines/infant/newborn分类
医药卫生引用本文复制引用
文思敏,王崇,潘雨辰,赵丹,王川,孔菲,牛俊奇,姜晶..新生儿乙型肝炎疫苗免疫低应答的影响因素分析[J].临床肝胆病杂志,2018,34(6):1198-1203,6.基金项目
十二五国家科技重大专项课题子课题(2012ZX10002001-001) （2012ZX10002001-001）
吉林省卫生计生科研计划(20152003) （20152003）
中国肝炎防治基金会-天晴肝病基金资助课题(TQGB20140137) （TQGB20140137）
